title: Optimizing senior's surgical care - Elder-friendly Approaches to the Surgical Environment (EASE) study: rationale and objectives.
abstract: BACKGROUND
  It is estimated that seniors (≥65 years old) account for >50% of acute inpatient hospital days and are presenting for surgical evaluation of acute illness in increasing numbers. Unfortunately, conventional acute care models rarely take into account needs of the elderly population. The failure to consider these special needs have resulted in poor outcomes, longer lengths of hospital stay and have likely increased the need for institutional care. Acute Care for the Elderly models on medical wards have demonstrated decreased cost, length of hospital stay, readmissions and improved cognition, function and patient/staff satisfaction. We hypothesize that specific Elder-friendly Approaches to the Surgical Environment (EASE) interventions will similarly improve health outcomes in a cost-effective manner.
  
  
  METHODS
  Prospective, before-after study with a concurrent control group. Four cohorts of 140 consecutively-screened older patients (≥65 years old) will be enrolled (560 patients in total). The EASE interventions involves co-locating all older surgical patients on a single unit, involving an interdisciplinary care team (including a geriatric specialist) in the development of individual care plans, implementing evidence-informed elder-friendly practices, use of a reconditioning program, and optimizing discharge planning. Subjects will be followed via chart review for their hospital stay, and will then complete in-person or telephone interviews at 6 weeks and 6 months after discharge. Measured outcomes include clinical (postoperative major in-hospital complication or death [primary composite outcome]; death or readmission within 30-days of initial discharge; length of hospital stay), humanistic (quality of life; functional, cognitive, and nutritional status) and economic (health care resource utilization and costs) endpoints. Within-site mean change scores will be computed for the composite primary outcome and the overall covariate-adjusted between-site pre-post difference will be the dependent variable analyzed using generalized linear mixed model procedures including adjustment for clustering.
  
  
  CONCLUSIONS
  Our findings will generate new knowledge on outcomes from acute surgical care in older patients and validate a novel elder-friendly surgical model including assessment of both clinical and economic benefits. If effective, we expect the EASE initiatives to be generalizable to other surgical centres.
  
  
  BACKGROUND
  Clinicaltrials.govidentifier: NCT02233153.
authors: Department of Surgery, University of Alberta, Edmonton, AB, Canada. khadaroo@ualberta.ca.|2D3.77 Walter C. Mackenzie Health Sciences Centre, 8440-112th Street, Edmonton, T6G 2B7, AB, Canada. khadaroo@ualberta.ca.
authors: Rachel G
authors: RG
authors: Khadaroo
authors: Department of Medicine, University of Alberta, Edmonton, AB, Canada. rpadwal@ualberta.ca.|Alberta Diabetes Institute, Edmonton, AB, Canada. rpadwal@ualberta.ca.
authors: Raj S
authors: RS
authors: Padwal
authors: Department of Medicine, University of Alberta, Edmonton, AB, Canada. adrian.wagg@ualberta.ca.|Alberta Seniors Health Strategic Clinical Network, Calgary, AB, Canada. adrian.wagg@ualberta.ca.
authors: Adrian S
authors: AS
authors: Wagg
authors: Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, AB, Canada. fclement@ucalgary.ca.
authors: Fiona
authors: F
authors: Clement
authors: Department of Surgery, University of Alberta, Edmonton, AB, Canada. lmw5@ualberta.ca.
authors: Lindsey M
authors: LM
authors: Warkentin
authors: Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, AB, Canada. Jayna.Holroyd-Leduc@albertahealthservices.ca.|Alberta Seniors Health Strategic Clinical Network, Calgary, AB, Canada. Jayna.Holroyd-Leduc@albertahealthservices.ca.
authors: Jayna
authors: J
authors: Holroyd-Leduc
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002170:Canada; D003362:Cost-Benefit Analysis; D016208:Databases, Factual; D013502:General Surgery / Q000191:economics / Q000458:organization & administration*; D006760:Hospitalization; D006801:Humans; D010351:Patient Discharge; D017060:Patient Satisfaction; D011446:Prospective Studies; D011788:Quality of Life; D011795:Surveys and Questionnaires