Geriatric surgery verification program can improve outcomes for older cancer patients in community hospitals

Key takeaways 

• The American College of Surgeons Geriatric Surgery Verification program significantly decreases hospital stays among older cancer patients, according to researchers who implemented the program at their institution. 

• After implementing the program, patients undergoing major abdominal oncologic procedures also maintained higher levels of independence and were more likely to be discharged home. 

• Researchers found the program addresses the unique needs of older cancer patients by focusing on multiple aspects of care. 

CHICAGO — Implementing the American College of Surgeons (ACS) Geriatric Surgery Verification (GSV) program leads to better postoperative outcomes and preserves independence in older cancer patients undergoing major abdominal procedures, according to a new study published in the Journal of the American College of Surgeons (JACS).

Cancer occurrences increase with age and older adults have unique needs when it comes to surgical treatments. The study was conducted at the Roger Williams Medical Center in Providence, Rhode Island, a 220-bed community hospital. The team evaluated the impact of the GSV program on patients aged 65 and older undergoing major abdominal oncologic operations.

“Older patients comprise an increasingly large share of surgical oncology cases and represent a group with unique needs and goals,” said study coauthor Ponnandai Somasundar, MD, chief of surgical oncology and geriatric surgery director at Roger Williams Medical Center and associate professor of surgery at Boston University. “It’s important to assess outcomes these patients value, such as being discharged to home and maintaining independence after surgery.”

The research compared outcomes between 57 patients treated before the hospital implemented the GSV program (control group) and 43 patients treated after the implementation of the GSV program (intervention group). Multiple short-term outcomes were tracked including length of hospital stay and where the patient was going to live after discharge. 

Key Findings

• Shorter Hospital Stays: With the GSV program in effect, patients’ average length of stay was significantly shorter (4.4 days) than the group treated before the implementation of GSV (6.5 days). 

• Patients More Likely to Be Discharged Home: Only 7.3% of patients in the intervention group were newly discharged to a care institution rather than their primary residence, compared to 24.1% in the control group. 

• Reduced Loss of Independence: GSV program implementation was associated with 72% lower odds of increased care needs at discharge, indicating higher levels of independence. 

Key components of GSV that likely contributed to these improved outcomes include comprehensive assessments, personalized care plans, prehabilitation, and strategies to mitigate postoperative risks like delirium and falls.

“Our study demonstrates that implementing the GSV program not only reduces how long patients stay in the hospital but also helps maintain the independence that is so crucial to our older patients,” said corresponding author Steve (Sung) Kwon, MD, MPH, FACS, surgical oncologist at Roger Williams Medical Center and director of Roger Williams Surgery and Cancer Outcomes Research and Equity (RWSCORE) center. “A program like GSV helps to prepare and manage older cancer patients perioperatively, addressing their specific needs and improving their overall quality of life.”

Community Hospitals and GSV

The study authors emphasized the significance and feasibility of adopting the GSV program in community hospital settings. 

“Most cancer care is delivered in community hospitals. By implementing programs like GSV, we can improve the quality of care and outcomes for older cancer patients where they receive their care,” Dr. Somasundar said.

Further studies are needed to explore the long-term outcomes of patients as well as to determine which aspects of GSV lead to these improved outcomes, the authors said. 

“We’re keeping track of patients’ outcomes regarding their long-term independence,” added Dr. Kwon. “More research will help us understand the full benefits of the GSV program for this vulnerable population.”

Study coauthors are Mercy Jimenez, MD; Omid Salehi, MD; Jayme Dandeneau, OCN, BSN; Jose Fernandez, MD; Joanna Chebl, MD; Lidia Vognar, MD; N. Joseph Espat, MD, FACS; Abdul Saied Calvino, MD, FACS; and James Koness, MD.

The study is published as an article in press on the JACS website. 

Author Disclosures: Nothing to disclose.

Citation: The Impact of American College of Surgeons’ Geriatric Surgery Verification Program in Patients Undergoing Major Abdominal Oncologic Operations at a Cancer Center Journal of the American College of Surgeons. DOI: 10.1097/XCS.0000000000001247

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About the American College of Surgeons 

The American College of Surgeons (ACS) is a scientific and educational organization of surgeons that was founded in 1913 to raise the standards of surgical practice and improve the quality of care for all surgical patients. The ACS is dedicated to the ethical and competent practice of surgery. Its achievements have significantly influenced the course of scientific surgery in America and have established it as an important advocate for all surgical patients. The ACS has approximately 90,000 members and is the largest organization of surgeons in the world. “FACS” designates that a surgeon is a Fellow of the American College of Surgeons.

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