Preoperative Geriatric Assessment Impact on Health Outcomes in Older Adults After Major Surgery A Retrospective Matched Study
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Background: Frailty increases surgical risk for older adults, yet structured preoperative geriatric assessment (PGA) remains underused. We evaluated whether structured, hospital-based PGA improves outcomes and reduces healthcare utilization in older patients undergoing major elective surgery. Participants and Setting: Adults ≥65 insured by Maccabi Healthcare Services (Israel) who underwent specified elective orthopedic or abdominal surgeries at Assuta Medical Center between 2019–2023. Methods: This retrospective matched case-control study linked clinical and administrative datasets. The intervention group (N=191) received PGA using an Adapted Surgical Frailty Score, while 3,068 controls underwent similar procedures without PGA. Controls were stratified by level of prior geriatric input and matched by age, sex, surgery type, and SES. Outcomes included one-year mortality, hospitalizations, ED visits, home care use, long-term care, and costs. Chi-square and t-tests were used to compare groups. Results: PGA was associated with significantly lower one-year mortality (2.6% vs. up to 12% in some controls, p<0.01) and reduced ED visits, hospitalizations, and home care utilization. Average monthly healthcare costs were lower in the PGA group during both immediate and extended postoperative periods. No significant differences were found in registry-based morbidity indicators, though trends favored the PGA group. Control groups with minimal or no geriatric input resembled the intervention group more than those with prior community-based consultations. Conclusions: Structured, hospital-based PGA may mitigate frailty-related surgical risks and reduce health system burden, supporting broader adoption within preoperative workflows. Future research should explore optimal timing, structure, and continuity of geriatric input to maximize benefit. Trial registration: This study was not registered in a clinical trial registry.
