THE VESPA PRE-OPERATIVE TOOL: A SCALE THAT PREDICTS POST-SURGICAL GENERAL AND GERIATRIC COMPLICATIONS

Abstract

In response to the increasing use of elective surgery among older patients, we implemented the Vulnerable Elderly Surgical Pathways and outcomes Assessment (VESPA) into an academic health system general pre-operative clinic (2008–2011) to predict post-operative complications.

We interviewed 770 patients age ≥70 years who had upcoming general surgery to assess 5 pre-operative activities of daily living (ADLs) recommended by the American College of Surgeons (bathing/dressing, transferring, shopping, meals), falls, depressive symptoms, and performed a brief cognitive examination. We also asked a novel question of whether they expected they could manage themselves alone upon discharge. We conducted chart review for geriatric and surgical complications and co-morbidity and collected Work-related Relative Value Units (wRVU, categorized into low/moderate/high tertiles).

Of the 770 interviewed patients, 736 had an operative procedure; of these, 14.3% had one of 5 ADL difficulties and 38.2% foresaw themselves unable to manage self-care alone. A quarter developed either geriatric or surgical complications, 18% had geriatric complications and 15% had surgical complications. ADL difficulty count (OR 1.2[1.0–1.5]), forseen difficulty with post-operative self-care (OR 1.5[1.0–2.2]), co-morbidity (OR 1.5[1.0–2.3]), male gender (OR 1.6[1.1–2.3]), and wRVUs (moderate vs low OR 1.9[1.1–3.4]; high vs low OR 8.9 [5.4–14.8]) all independently predicted post-operative complications (overall model Area Under the Curve [AUC]=0.77), whereas age was not significant (OR 1.0[0.98–1.1]. Using these results, a whole-point VESPA score used alone to predict complications also demonstrated excellent fit (AUC=0.76).

In conclusion, pre-operative geriatric assessment of the oldest patients is feasible in general pre-operative clinic and can help identify higher-risk patients.