Jahnigen Award Supports Development of Quality Indicators Aimed at Improving Care of Older Surgery Patients

While operating on an 80-year-old isn't dramatically different from operating on a young adult, caring for an elderly patient before and after surgery is, says Clifford Y. Ko, MD, associate professor of surgery and director of the Center for Surgical Outcomes and Quality at UCLA.

"It's not so much that we will operate differently on an older patient, but, rather, that there are geriatric-related issues that arise before and after," explains Dr. Ko, a winner of a 2003 Dennis W. Jahnigen Career Development Scholars Award that has supported his work to develop quality indicators aimed at improving the care of older surgical patients.

Because older patients are more likely to have multiple and more severe chronic medical problems, such as diabetes, heart, lung, kidney disease, etc., than are younger patients, their recovery can be more complicated, Dr. Ko explains. Such co-morbidities may, among other things, slow healing, increase risks of post-operative problems like infection, and extend hospital stays.

"We also have to deal with issues like delirium and polypharmacy among geriatric surgical patients," Dr. Ko adds. "While you may have to deal with these issues with younger patients, these things are much more prevalent in elderly surgical patients. And given that the population is aging, we're probably going to be doing more operations on elderly people."

In addition to providing follow-up care that takes into account older patients' increased risks of post-surgical complications, providing pre-surgical care aimed at preventing complications such as delirium can make a difference, Dr. Ko adds.

With the support of his two-year Jahnigen award, Dr. Ko and colleagues at UCLA and RAND have developed quality measures for abdominal surgery in the elderly which they've published and presented widely. With the subsequent support of a National Institute of Aging (NIA) grant, Dr. Ko is now leading further research aimed at evaluating and improving the quality of care afforded older patients undergoing major surgery of all kinds.

"The Jahnigen was terrific, it provided the support necessary to start work on development of these quality indicators," Dr. Ko says. "An extension of that work is what led to the NIA grant, which is now supporting the development of quality indicators not just in one area of surgery, but in all areas of inpatient surgery for older patients. It's really exciting. We have an expert panel of surgical specialists, geriatrics leaders, and other specialists working on ways to measure and improve the quality of geriatric care in all surgical fields."

Administered by the American Geriatrics Society (AGS) and funded by the John A. Hartford Foundation and the Atlantic Philanthropies, the two-year Jahnigen awards support junior faculty in 10 specialties, including general surgery, enabling them to establish careers in education and research concerning the geriatric aspects of their specialties. In 2007 as many as 11 researchers will receive Jahnigen awards. Each winner receives $150,000 over the course of two years. Recipients' institutions provide a match of $50,000 over the two-year period.

To improve surgical outcomes for older patients, Dr. Ko is also collaborating with the American College of Surgeons as well as researcher-educators involved in a second AGS program, the Society's Geriatrics-for-Specialists Initiative (GSI). Funded by the John A. Hartford Foundation, the GSI aims to help prepare surgeons and other medical specialists to meet the healthcare needs of the elderly. Among other things, the multidisciplinary team of participants hope to develop quality improvement programs for hospitals caring for older surgical patients.