88REDUCING LENGTH OF HOSPITAL STAY FOR OLDER ELECTIVE SURGICAL INPATIENTS: FINDINGS OF A SYSTEMATIC REVIEW

Abstract

Introduction: Older inpatients may present for elective surgery with issues such including frailty, polypharmacy, cognitive decline or multi-morbidity. Furthermore, previously unidentified problems may be revealed under surgical stress which could complicate recovery. As such, older inpatients are at risk of increased length of stay (LOS) in hospital, and adverse events during or after surgery. Increased LOS is associated with greater risk of in-hospital morbidity and places extra demand on resources. It is essential to evaluate the effectiveness of organisational interventions to reduce LOS and improve recovery. We present an overview of the findings and implications for research, of a systematic review of the effectiveness of hospital-led interventions to reduce LOS in older elective surgical inpatients. Method(s): Bibliographic database searches were supplemented by citation searches, web searches and consultation with stakeholders. We sought comparative studies evaluating hospital-led multicomponent interventions to improve recovery and/or reduce LOS in samples of patients aged 60 or over. Two independent reviewers conducted screening, data extraction and quality appraisal. Impact on LOS was the primary outcome, but all other outcomes were evaluated. We regularly consulted with clinical experts and members of the public throughout the review. Result(s): We identified 10448 potentially relevant records, yielding 218 included studies. We prioritised 73 studies for synthesis, predominantly regarding colorectal surgery and lower limb arthroplasty. Enhanced Recovery Programmes and Prehabilitation interventions were most common, often leading to improved recovery or reduced LOS, without detriment to other outcomes. Non-clinical outcomes were rarely reported and patient follow-up beyond 30 days was largely absent. Conclusion(s): Interventions to reduce LOS and/or improve recovery following elective surgery can be effective in older adults. Future trials should focus on identifying factors influencing implementation and consistent uptake of interventions across institutions. Inhospital patient voice and longer-term implications of reduced LOS for patient recovery and the wider health and social care system, must be considered.