Implementation of Comprehensive Geriatric Assessment based perioperative medicine services to improve clinical outcomes for older patients undergoing elective and emergency surgery with cost effectiveness (POPS-SUp)

Older people have more operations than younger people but often have more complications related to other problems like heart disease or poor memory. These problems need treatment from experts called geriatricians. It is not usual to have geriatricians managing older people who need operations in the NHS. A service called Perioperative medicine for Older People undergoing Surgery (POPS) was set-up at one NHS hospital to help older people get better outcomes after operations. POPS services reduce complications after surgery, help people leave hospital sooner and save the NHS money. Only some NHS hospitals have set-up POPS services, meaning not all NHS patients get this care. We know that setting up POPS services can be hard, but our work has shown this can be done. Our research will test how new POPS services can be set-up in more NHS hospitals across the UK to improve care for older patients having operations and save money for the NHS. We will use a mixed methods approach to see if we can set-up POPS services in 18 NHS hospitals; whether we can do this quickly; how well services run; whether services help people to get better more quickly after an operation and whether this saves the NHS money. We will collect information about how long people stay in hospital after an operation, describe complications after surgery and measure patients’ quality of life. We will talk to patients and staff about their experiences of new POPS services. Our research will use a mix of information from staff, hospital records and patients and carers. We are seeking CAG approval for one aspect of the study where we will use routinely collected patient level data without consent. This approach was co-designed with our patient and public partners to minimise burden, use routine data effectively and improve care.