Pre-Operative Geri Assessment: Vicky Tang and Houman Javedan

 

We love getting requests from listeners for podcast topics.  This request came from geriatricians we met at the annual American Geriatrics Society meeting in Chicago.  They wanted to know more about what a geriatrician should do in a pre-operative risk assessment.  So we invited Vicky Tang and Houman Javedan, two geriatricians and leaders in the pre-operative assessment and prehab space, to talk with us.

As is our style, we backed up to some bigger questions, including:

-Why do patients need a geriatric assessment pre-operatively?-Why are our surgical colleagues asking us? Is it due to liability concerns? -Why do we do them?  Recognizing we may have different motivations than our consultants (hint: stealth geriatrics) -How does the comprehensive geriatric assessment fit int? Do the 4Ms fit into pre-operative assessment if at all? (an entertaining disagreement ensued) -Must a geriatrician do this? -What is the Geriatric Surgery Verification Program? -What’s the most important part of 

Many links from our guests below.

And please forgive my Spanish on the song, I tried! Thanks to sons Kai and Renn on Ukulele and Bass for making it sound better.

-Alex

From Vicky:

1. Systematic review of Prehab https://pubmed.ncbi.nlm.nih.gov/39655991/

2. Geriatric Surgery Verification Program https://www.facs.org/quality-programs/accreditation-and-verification/geriatric-surgery-verification/ 

3. shared decision making in surgical patients https://pubmed.ncbi.nlm.nih.gov/40551447/ 

From Houman:

Geriatric Surgical Co-management Evidence

1.    Trauma survival with geriatric assessment 2022- https://pubmed.ncbi.nlm.nih.gov/36102764/ 2.    Hip fracture survival benefit meta-analysis 2014- https://pubmed.ncbi.nlm.nih.gov/23912859/ 3.    Elective abdominal surgery benefits POSH program 2018- https://pubmed.ncbi.nlm.nih.gov/29299599/ 4.    POSH Program for Spine 2021- https://pubmed.ncbi.nlm.nih.gov/33382460/ 5.    Elective orthopedic joints ED readmission decreases 2024 - https://pubmed.ncbi.nlm.nih.gov/39715294/ 6.    The need for geriatricians, tools and education models (aka Ms) are not enough - https://pubmed.ncbi.nlm.nih.gov/30916758/

Sub Topics

7.    Utility of minicog and where our improved local mortality of 18% and delirium of 11% reported - https://pubmed.ncbi.nlm.nih.gov/27147687/

8.    Geriatrician performed CGA-FI best at predicting mortality in rib fractures 2025 - https://pubmed.ncbi.nlm.nih.gov/39800638/

9.    Geriatrician performed CGA-FI predicting mortality better than age in hip fractures 2024- https://pubmed.ncbi.nlm.nih.gov/39007664/ 

10.  Multidomain frailty assessment and surgery showing severely frail patients at risk of mortality even with low risk procedures (eg. Cystoscopy) - https://pubmed.ncbi.nlm.nih.gov/31721994/

11.  Different outcomes for hip fracture surgery in the severely frail - https://pubmed.ncbi.nlm.nih.gov/38892908/

12.  Complexity of aging physiology- example of prostaglandin based free water excretion in collecting duct of aging kidney first paragraph on page 360- https://pubmed.ncbi.nlm.nih.gov/36948780/