Materials and Methods
The study was conducted at an 800-bedded hospital providing
tertiary-level care for vascular surgery patients. This was a
single-centre, non-randomised descriptive between subjects,
before-and-after design comparing pre-existing practice with a model of
care previously shown to be effective in other surgical
settings11. This comprised daily senior-led
(registrar/consultant) medical liaison review provided by geriatric
medicine physicians. This service was provided within normal working
hours (0800-1700, Monday to Friday). Patient identification was
triggered through direct liaison with the vascular surgery team and
daily attendance to the vascular surgery ward to case-find.
Electronic records and patient case notes were analysed for all patients
aged 65 years and older admitted for one or more nights. Notes were
analysed retrospectively during two three-month periods across two
consecutive years (January-March 2017 and 2018) to allow pre- and
post-intervention analysis.
Data collection was conducted by a team of doctors and one medical
student working within the Department of Medicine for Older People.
Notes were requested from business intelligence services. Patient
demographics were recorded including sex, age, admission type
(emergency/elective), source of admission (home/other hospital/care
home), operation type, comorbidities and frailty scores. Comorbidities
were recorded using the Charlson comorbidity index12.
Frailty was recorded using the Clinical Frailty
Scale13. Outcome variables included LOS and for
patients undergoing surgery, the number of complications suffered.
Complications were recorded according to actual number and using
guidance from The Clavien-Dindo system14. Other
information recorded included admission to intensive care, 30-day
readmission rates and inpatient mortality.
Statistical analysis was performed using SPSS Statistics 23.
Between-group differences were analysed using correlation analysis,
chi-square test of association, odds ratios, two-sample independent
tests, and Kaplan-Meier analysis as appropriate. Multiple regression
analyses were used to determine whether putative risk factors were
relevant in their impact on LOS.