Preoperative Geriatric Assessment for Surgery

Overseen By Julia R Berian, MD, MS

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: University of Wisconsin, Madison

Disqualifiers: Non-English speakers, No caregiver, Cognitive impairment, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: Unknown

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial explores a new method to help older adults prepare for major surgery. It aims to determine if a Comprehensive Geriatric Assessment (CGA) implementation package can improve access to resources that enhance surgical outcomes. Participants include older adults planning major surgery and their healthcare providers. The trial is open to patients aged 85 and older, or those 60 and older with health issues such as vision or hearing loss, cognitive concerns, or multiple medical conditions. The study will compare results from patients using the new package to older data from those who received standard care. As an unphased trial, this study provides a unique opportunity for patients to contribute to innovative approaches that could improve surgical outcomes for older adults.

Will I have to stop taking my current medications?

The trial information does not specify whether participants need to stop taking their current medications.

What prior data suggests that this implementation package is safe for older adults preparing for surgery?

Research has shown that a comprehensive geriatric assessment (CGA) before surgery can reduce the risk of complications for older adults. One study found that individuals who underwent a CGA experienced less postoperative delirium compared to those without the assessment. Specifically, 28.5% of those with the CGA experienced confusion, while 37.0% of those without it did. This indicates that CGA is both safe and beneficial in preparing older adults for surgery. Other studies have found that CGA outperforms traditional methods in identifying older patients at risk for complications. Overall, these findings suggest that the CGA process is well-tolerated and could improve surgical outcomes for older adults. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about the Preoperative Geriatric Assessment (CGA) implementation package because it offers a structured way to evaluate older patients before surgery, potentially improving their outcomes. Unlike standard routine clinical care, which may not consistently integrate comprehensive geriatric evaluations, this approach emphasizes a tailored assessment that considers the unique needs and risks of older adults. By systematically identifying and addressing factors like frailty, cognitive function, and social support before surgery, the CGA implementation package aims to enhance surgical preparedness and recovery for elderly patients.

What evidence suggests that this implementation package is effective for preoperative geriatric assessment?

This trial will compare a comprehensive geriatric assessment (CGA) implementation package with routine clinical care for older adults before surgery. Research has shown that a thorough health check-up like CGA is very helpful. Studies have found that CGA can improve results by customizing care to meet the unique needs of older patients. It helps identify risks such as confusion after surgery and addresses them effectively. CGA is also associated with better overall care and fewer complications, making it a promising method for improving surgical outcomes in older adults. ^{3 6 7 8 9}

Who Is on the Research Team?

Julia R Berian, MD, MS

Principal Investigator

University of Wisconsin, Madison

Are You a Good Fit for This Trial?

This trial is for older adults who are preparing for major surgery. It aims to see if a new program (implementation package) can help them get ready and improve their access to pre-surgery assessments.

Inclusion Criteria

I am 85 or older and a surgeon has referred me for a pre-surgery assessment.

I am over 60 with health issues like vision/hearing loss or poor nutrition, referred for a pre-surgery assessment.

Provider working in clinic where pCGA is performed

Exclusion Criteria

Patients category 1 or 2 who are not fluent in English

I am unable to give consent due to cognitive issues and do not have a caregiver.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Implementation

Participants receive care using an implementation package for CGA use before surgery

6-12 months

Regular visits as per clinic schedule

Follow-up

Participants are monitored for adoption and reach of the CGA implementation package

6-12 months

What Are the Treatments Tested in This Trial?

Interventions

• Implementation Package for CGA
• Routine Clinical Care

Trial Overview The study is testing an 'implementation package' designed to assist in the preparation of older adults for major surgery, comparing its effectiveness with routine clinical care against past data.

How Is the Trial Designed?

Group I: Post Implementation Experimental Treatment 2 Interventions

Participants will be recruited from two surgery clinics in the Post-Implementation group. They will receive care using an implementation package for CGA use before surgery. The control group will be historic baseline data. That is, older surgical patients who were treated Pre-Implementation. These patients would have received standard, routine clinical care without the use of the implementation package.

Who Is Running the Clinical Trial?

University of Wisconsin, Madison

Lead Sponsor

Trials

1,249

Recruited

3,255,000+

National Institute on Aging (NIA)

Collaborator

Trials

1,841

Recruited

28,150,000+

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC9594523/

Comprehensive geriatric assessment (CGA) in perioperative ... Comprehensive geriatric assessment (CGA) is a complex intervention applied to older people with evidence of benefit in medical populations.

2. bmcgeriatr.biomedcentral.com bmcgeriatr.biomedcentral.com/articles/10.1186/s12877-025-05922-9

Experiences of participating in a preoperative comprehensive ... Comprehensive geriatric assessment (CGA) and care has shown benefits for frail older adults across various care settings.

3. researchprotocols.org researchprotocols.org/2024/1/e59428

Using Systems Engineering and Implementation Science ... A preoperative comprehensive geriatric assessment (pCGA) is recommended to reduce risk and improve surgical care delivery for this population, ...

4. nature.com nature.com/articles/s41598-024-78940-z

Comprehensive geriatric assessment for predicting ... This study aims to identify geriatric screening tools to predict preoperative delirium and explore the high-risk elderly patients undergoing oral maxillofacial ...

5. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC8061210/

Effects of comprehensive geriatric care models on ... The objective of this systematic review and meta-analysis is to determine whether the comprehensive geriatric care models improved clinical outcomes.

6. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC11356442/

The impact of comprehensive geriatric assessment on ... Comprehensive geriatric assessment reduced the rate of postoperative delirium (28.5% vs. 37.0%; OR: 0.63; CI: 0.47–0.85; I2: 54%; P = 0.003) based on pooled ...

7. associationofanaesthetists-publications.onlinelibrary.wiley.com associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/10.1111/anae.12494

The impact of pre‐operative comprehensive geriatric ... Pre-operative comprehensive geriatric assessment seems a plausible method for reducing adverse postoperative outcomes. The objectives of this ...

8. pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov/39410557/

Comprehensive Peri-Operative Risk Assessment and ... CGA is a superior predictive tool compared to traditional models, as it more accurately identifies elderly patients at higher risk of complications.

9. sciencedirect.com sciencedirect.com/science/article/abs/pii/S187940682500013X

Systematic Review The effect of comprehensive geriatric ... This systematic review summarises the effects of GA/CGA compared to usual care for older adults with cancer intended for surgery.