title: A collaborative transdisciplinary "geriatric surgery service" ensures consistent successful outcomes in elderly colorectal surgery patients.
abstract: BACKGROUND
  We hypothesized that a dedicated collaborative transdisciplinary Geriatric Surgery Service (GSS) will improve care for elderly colorectal surgery patients.
  
  
  METHODS
  Patients older than 75 years of age who underwent major colorectal surgery were included in this study. The Geriatric Surgery Service employed a transdisciplinary, collaborative model of care. There were frequent quality reviews and a patient-centered culture was ensured. Treatment protocols and checklists were instituted. Perioperative outcome data were collected prospectively between 2007 and 2009. These data were compared to those from similar patients not managed by the service. Success and failure of surgical treatment of the two groups were analyzed using CUSUM methodology. Failure was defined as mortality, prolonged hospital stay for any reason, including morbidity, and failure to regain preoperative function by 6 weeks.
  
  
  RESULTS
  Twenty-nine patients managed by the GSS were compared to 52 patients who underwent standard treatment. The median age of the patients managed by the GSS was higher but there was no difference in the ASA score and predicted morbidity scores based on the POSSUM model. The GSS achieved lower mortality and major complication rates. A large majority (84.6%) of the patients managed by the GSS returned to preoperative functional status by 6 weeks. The GSS was able to produce a trend of successively desired outcomes consistently leading to the CUSUM curve exhibiting a sustained downward slope. This was in contrast to patients not managed by the GSS.
  
  
  CONCLUSIONS
  The Geriatric Surgery Service, through its transdisciplinary, collaborative care processes, was able to achieve sustained superior outcomes compared to standard management.
authors.affiliation: Department of Surgery, Alexandra Health, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore, 768828, Singapore. kokyangtan@gmail.com
authors.forename: Kok-Yang
authors.initials: KY
authors.lastname: Tan
authors.forename: Phyllis
authors.initials: P
authors.lastname: Tan
authors.forename: Lawrence
authors.initials: L
authors.lastname: Tan
mesh_terms: D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000601:surgery*; D003107:Colorectal Surgery / Q000458:organization & administration; D006299:Health Services for the Aged; D006801:Humans; D010348:Patient Care Team; D011446:Prospective Studies; D016896:Treatment Outcome