Preoperative Geriatric Assessment Impact on Health Outcomes in Older Adults After Major Surgery A Retrospective Matched Study

Preoperative Geriatric Assessment Impact on Health Outcomes in Older Adults After Major Surgery A Retrospective Matched Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Preoperative Geriatric Assessment Impact on Health Outcomes in Older Adults After Major Surgery A Retrospective Matched Study Reut Ron, Hadar Goldstein, Zorian Radomyslsky This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7262797/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract 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. Preoperative geriatric assessment frailty surgical outcomes older adults healthcare utilization Figures Figure 1 Key Points Key Points Structured, hospital-based preoperative geriatric assessment (PGA) was associated with lower one-year mortality and reduced healthcare utilization among older adults undergoing major elective surgery. Patients receiving PGA showed lower rates of ED visits, hospitalizations, home care use, and institutionalization compared to matched controls. Findings highlight the added value of integrating PGA within surgical pathways rather than relying solely on community-based or fragmented assessments. Why does this paper matter? This study provides real-world evidence supporting broader implementation of structured PGA to improve surgical outcomes and system-level efficiency for frail older adults. Background As populations age, frailty has emerged as one of the key syndromes complicating surgical care for older adults. Frailty is a multidimensional syndrome with decreased physiological reserves and increased vulnerability, involving genetic, biological, functional, cognitive, psychological, and socio-economic factors 1 . Frailty is estimated to affect 10–15% of community-dwelling adults over age 65, and up to 25–50% among older adults undergoing major surgery 2 – 3 . Management strategies and new frameworks for screening and treating frailty have emerged 4 . Preoperative Geriatric Assessment (PGA) is a comprehensive, approach that evaluates frailty, nutrition, cognition, and function to optimize elderly patients before surgery. It involves assessing frailty, nutritional status, cognitive function, and functional capabilities 5 – 6 . This assessment goes beyond standard preoperative evaluations by addressing geriatric syndromes and age-related physiological changes 7 . The process aims to identify and mitigate potential risks, improve decision-making, and enhance postoperative outcomes 5 , 8 , but often it is reserved for select high-risk patients rather than used systematically 9 . Studies have shown that PGA has emerged as a valuable tool for predicting postoperative outcomes and healthcare utilization in older adults undergoing major surgery. PGA can prompt various interventions, including medication changes, lifestyle advice, and individualized care plans 10 . Frailty is associated with higher long-term healthcare utilization, including increased inpatient admissions, emergency department visits, and nursing home encounters for up to 24 months post-surgery 11 . However, implementation remains limited due to time, cost, workforce shortages, and poor integration with surgical teams 12 . This study aimed to evaluate whether a structured, hospital-based PGA prior to elective major surgery improves postoperative outcomes in elderly patients. To address this question, we conducted a retrospective matched case-control study at a major surgical center in Israel, where a structured geriatric assessment program was implemented as part of its routine preoperative workflow for older adults over age 65, comparing patients who underwent comprehensive GA with similar patients who did not receive such an assessment. This study examines the real-world impact of PGA on outcomes and utilization. Methods The study used linked clinical and administrative datasets from Maccabi Healthcare Services and Assuta Medical Center (2019–2023), providing a comprehensive longitudinal view of each patient’s care trajectory. Eligible participants were adults ≥ 65 undergoing common elective orthopedic or abdominal surgeries with general or regional anesthesia, identified as high-volume procedures with frailty risk. The intervention group completed an Adapted Surgical Frailty Score covering comorbidities, function, cognition, nutrition, delirium risk, and falls. This approach builds on practical two-stage frailty assessments shown effective in older surgical populations by Hosler et al 13 . Only fully assessed patients were included. The control group comprised 3,068 patients drawn from the national database of Maccabi, who underwent the same surgical procedures during the same period but did not receive a structured PGA at the hospital. Matching used a cluster-based approach by sex, surgery type, birth year, and socioeconomic status. For the purpose of this analysis, we focused on a subset of 191 patients who underwent one of the pre-specified orthopedic and abdominal procedures best aligned with available control group data. Baseline covariates (age, sex, SES, comorbidities) showed no significant differences (Table 1 ), supporting adequate matching; multivariable modeling was not needed. Nevertheless, we recognize that statistical non-significance does not fully rule out residual confounding, and future studies should consider additional adjustment techniques such as propensity score matching or multivariable regression. Table 1 Baseline Demographic, Clinical, and Surgical Characteristics of the Study Population by Group Intervention (N = 191) Control 1 (N = 348) Control 2 (N = 240) Control 3 (N = 601) Control 4 (N = 1,670) p-value vs. intervention Age (mean ± SD) 80.78 ± 6.93 80.73 ± 6.78 80.81 ± 6.65 81.01 ± 7.12 81.03 ± 6.25 All not SS Female (%) 53.93 63.51 61.67 50.58 51.44 C1 = 0.03 Socioeconomic Status > 5 (%) 64.41 51.44 62.52 66.39 63.71 C1 < 0.01 Preoperative Prevalence of Health Conditions in EMR registries (%) Falling risk 98.43 99.43 99.17 98.67 97.19 All not SS Cognitive impairment 26.70 54.60 55.00 25.46 24.91 C1, C2 < 0.01 Nutritional disorders 87.43 93.10 94.58 90.85 89.52 C1, C2 < 0.04 Surgery type (%) Knee replacement 41.36 22.41 22.50 45.76 44.25 C1, C2 < 0.01 Hip replacement 25.65 61.78 66.25 24.63 25.75 Bilateral hernia repair 16.75 9.48 4.17 15.31 14.07 Unilateral hernia repair 7.85 2.30 4.58 6.16 7.19 Other hernia 5.76 3.16 1.25 4.99 7.19 PO ventral hernia repair 2.62 0.86 1.25 3.16 1.56 Notes : EMR = Electronic Medical Record; "All not SS" indicates that no significant differences were found; In BOLD statistically significant results < 0.05. Control 1: Community-based multidisciplinary geriatric consultation; Control 2: Solo visit with a community geriatrician; Control 3: Basic preoperative assessments (visit by primary care physician or pharmacist-led medication review); Control 4: No geriatric-related care in the year prior to surgery. To further refine the comparison and to examine potential gradations of geriatric input, the control group was internally stratified into four subgroups according to their documented exposure to geriatric-related healthcare services in the year preceding surgery: Control Group 1 - patients who underwent a multidisciplinary, community-based geriatric consultation. Control Group 2 -patients who received a solo consultation with a community-based geriatrician. Control Group 3 - patients who had minimal geriatric-oriented care, such as a clinical pharmacist deprescribing consultation or a structured primary care physician visit. Control Group 4 - patients who had no recorded geriatric intervention. This structure allowed evaluation of community-level alternatives to hospital-based PGA. Down-sampling improved comparability. Down-sampling was applied in larger groups to improve baseline comparability. Outcomes included mortality and indicators of acute clinical deterioration, such as hospital readmissions and emergency department visits, markers of healthcare utilization and continuity of care and specialist follow-ups. Healthcare expenditures were calculated based on the total direct costs to the health plan, including inpatient care, emergency department visits, outpatient consultations, diagnostics, procedures, prescription medications, and long-term services. All values were estimated using standardized tariffs set by the Israeli Ministry of Health and Maccabi Healthcare Services. All data were analyzed using SPSS, R, and Microsoft Excel. Descriptive statistics were used to summarize the characteristics of the study population and to describe key outcome variables. Group comparisons were conducted using chi-square tests for categorical variables and t-tests or their non-parametric equivalents for continuous variables, depending on distributional assumptions. In instances where expected cell counts were low, Fisher’s exact test was applied instead of the chi-square test to ensure validity. Statistical significance was defined as a two-tailed p-value less than 0.05. The study was approved by the ethics committees of both Assuta Medical Centers (Approval #0031-23-ASMC) and Maccabi Healthcare Services (Approval #MHS-0079-23). Data extraction, linkage, and statistical analyses were conducted in accordance with data protection regulations and patient confidentiality protocols. This manuscript was edited for language and style using a large language model (ChatGPT, OpenAI), under the supervision of the corresponding author. No LLM was involved in data analysis, interpretation, or the generation of original content. Results 1. Study Population Characteristics The population included 3,050 patients ≥ 65 who underwent elective major surgery (2019–2023): 191 received structured hospital-based PGA, and 2,859 were grouped by prior geriatric care: multidisciplinary (Control 1, N = 348), solo geriatrician (Control 2, N = 240), minimal (Control 3, N = 601), or none (Control 4, N = 1,670). Table 1 presents the baseline demographic, clinical, and surgical characteristics of the study population. Mean age was ~ 81 years with no significant differences; gender and SES were similar, except for more women and lower SES in Control 1. Nearly all patients were flagged for fall risk with no group differences. Cognitive impairment and nutritional disorders were more common in Controls 1 and 2 (Table 1 ), indicating baseline differences in patient profiles. Knee replacements were more common in the intervention group, while Controls 1 and 2 had more hip replacements (significant differences). In summary, control Groups 3 and 4 (representing patients with minimal or no preoperative geriatric care) closely resembled the intervention group in terms of age, SES, gender, comorbidity profiles, and surgery types. In contrast, Control Groups 1 and 2, which included patients who had undergone more structured community-based geriatric assessments, differed more substantially from the intervention group on several key characteristics. 2. Mortality and morbidity One-year mortality following surgery was substantially lower in the intervention group (2.62%) compared to all control groups. The difference was statistically significant when compared to Control 1 (12.07%) and Control 2 (12.08%) (p < 0.01), as well as to Control 3 (6.99%) (p = 0.04). The comparison with Control 4 (5.39%) did not reach statistical significance (p = 0.14). Across all clinical status indicators, captured through registry entries indicating either a new diagnosis or a status update reflecting clinically significant morbidity, no statistically significant differences were observed between the intervention and control groups at 30, 180, or 365 days post-surgery. The full set of outcomes, including falling risk, cognitive impairment, nutritional disorders, bone disorders, and heart conditions, is detailed in Table 2 . Table 2 Registry entry or status update post-surgery Intervention (N = 191) Control 1 (N = 348) Control 2 (N = 240) Control 3 (N = 601) Control 4 (N = 1,670) p-value vs. intervention Falling risk (%) Within 30 days post-surgery 4.19 3.45 2.92 5.99 5.27 All not SS Within 180 days post-surgery 13.61 12.93 13.33 16.47 13.61 Within 365 days post-surgery 25.13 23.56 20.42 24.29 25.13 Cognitive impairment (%) Within 30 days post-surgery 0.52 0.86 0.42 0.50 0.18 All not SS Within 180 days post-surgery 3.66 5.75 5.42 2.00 2.04 Within 365 days post-surgery 4.71 7.18 8.75 3.49 3.59 Nutritional disorders (%) Within 30 days post-surgery 2.62 0.57 1.67 1.83 1.08 All not SS Within 180 days post-surgery 9.95 10.06 8.75 9.98 7.01 Within 365 days post-surgery 15.18 18.39 12.50 15.47 12.99 Bone Disorders (%) Within 30 days post-surgery 0.86 0.42 1.16 1.08 0.86 All not SS Within 180 days post-surgery 4.71 4.60 7.92 3.83 4.61 Within 365 days post-surgery 6.81 6.90 12.50 6.16 5.87 Heart Condition (%) Within 30 days post-surgery 0.52 0.00 1.67 0.17 0.84 All not SS Within 180 days post-surgery 1.57 2.87 3.75 2.16 2.81 Within 365 days post-surgery 3.14 4.60 5.00 4.49 4.85 Notes : "All not SS" indicates that no significant differences were found. Control 1: Community-based multidisciplinary geriatric consultation; Control 2: Solo visit with a community geriatrician; Control 3: Basic preoperative assessments (visit by primary care physician or pharmacist-led medication review); Control 4: No geriatric-related care in the year prior to surgery. Falling risk and other morbidity indicators showed no significant differences between groups (Table 2 ). The proportion of patients with cognitive impairment at 365 days was 4.7% in the intervention group, compared to 7.2% in Control 1 and 8.8% in Control 2. Rates in Controls 3 and 4 were closer to those in the intervention group (3.5% and 3.6%, respectively), though the differences across groups did not reach significance. Nutritional disorders were recorded in 15.2% of intervention patients at one year, similar to Control 3 (15.5%) and lower than Control 1 (18.4%). Control 4 showed a somewhat lower rate (13.0%). Again, no significant group-level differences were identified. For bone disorders, the highest one-year rate was observed in Control 2 (12.5%), while the intervention group had a lower rate of 6.8%, comparable to other control groups. Heart conditions were infrequent across all groups. At 365 days, rates ranged from 3.1% in the intervention group to 5.0% in Control 2, without statistically significant differences. Overall, none of the registry-based indicators showed statistically significant variation between the intervention and control groups at any time point. 3. ED visits, Hospitalizations and Healthcare Utilization Differences in healthcare utilization and specialist consultations were observed between the intervention and control groups throughout the first year following surgery (Table 3 ). Table 3 Healthcare Utilization, and Specialist Visits During the First Year After Surgery by Study Group Intervention (N = 191) Control 1 (N = 348) Control 2 (N = 240) Control 3 (N = 601) Control 4 (N = 1,670) p-value vs. intervention ED visits (% of patients with at least one visit) Within 30 days post-surgery 15.18 57.76 59.58 30.78 31.80 All < 0.01 Within 180 days post-surgery 31.94 66.09 65.83 41.76 40.06 All < 0.05 Within 365 days post-surgery 43.46 70.69 70.42 49.58 46.53 C1, C2 < 0.01 Mean number of ED visits Within 30 days post-surgery 0.16 0.81 0.84 0.43 0.44 All < 0.01 Within 180 days post-surgery 0.43 1.27 1.25 0.76 0.68 All < 0.05 Within 365 days post-surgery 0.75 1.54 1.59 1.05 0.89 C1, C2, C3 < 0.03 Mean number of hospitalizations Within 30 days post-surgery 1.15 1.87 1.92 1.46 1.48 All < 0.01 Within 180 days post-surgery 1.41 2.55 2.50 1.86 1.82 All < 0.01 Within 365 days post-surgery 1.71 2.92 2.82 2.17 2.07 All < 0.01 Family physician visit (% of patients with at least one visit) Within 30 days post-surgery 84.82 69.25 73.75 81.36 73.59 C1, C2, C4 < 0.01 Within 180 days post-surgery 98.43 88.22 93.33 95.67 93.89 C1, C2, C4 < 0.05 Within 365 days post-surgery 98.95 89.08 93.75 96.01 94.85 C1, C2, C4 < 0.05 Geriatrician consultation visit (% of patients with at least one visit) Within 30 days post-surgery 1.05 6.90 4.58 1.33 0.96 C1 < 0.01 Within 180 days post-surgery 9.42 31.61 26.25 5.16 4.37 All < 0.05 Within 365 days post-surgery 12.04 39.94 34.17 8.82 7.01 C1, C2, C4 < 0.05 General surgery specialist consultation (% of patients with at least one visit) Within 30 days post-surgery 23.04 12.64 7.08 21.80 21.92 C1, C2 < 0.01 Within 180 days post-surgery 36.13 19.93 17.08 32.28 30.60 C1, C2 < 0.01 Within 365 days post-surgery 42.93 26.44 22.50 39.93 35.99 C1, C2 < 0.01 Pain specialist consultation (% of patients with at least one visit) Within 30 days post-surgery 1.57 0.00 0.00 0.33 0.18 C1, C4 < 0.05 Within 180 days post-surgery 5.76 2.87 2.08 3.00 1.68 C4 < 0.01 Within 365 days post-surgery 7.85 4.89 2.92 3.83 3.23 C2, C3, C4 < 0.05 Social work consultation (% of patients with at least one visit) Within 30 days post-surgery 0.52 2.59 2.08 1.00 0.72 All not SS Within 180 days post-surgery 2.62 6.03 7.08 3.99 2.34 Within 365 days post-surgery 5.24 9.20 9.58 6.99 3.47 Notes : ED = Emergency Department; "All not SS" indicates that no significant differences were found. In BOLD statistically significant results < 0.05. Control 1: Community-based multidisciplinary geriatric consultation; Control 2: Solo visit with a community geriatrician; Control 3: Basic preoperative assessments (visit by primary care physician or pharmacist-led medication review); Control 4: No geriatric-related care in the year prior to surgery. Patients in the intervention group had lower rates of emergency department (ED) visits at all time points. Within 30 days post-surgery, 15.2% had at least one ED visit, compared to 57.8% in Control 1 and 59.6% in Control 2 (p < 0.01). This trend continued throughout the year, with consistently fewer ED visits and hospitalizations in the intervention group. (p < 0.01). Family physician and surgery specialist visits were more frequent in the intervention group, while geriatrician consultations were lower. (p < 0.01). Differences were also noted in pain specialist consultations, with the intervention group having a higher proportion of patients seen at 365 days (7.85%) compared to multiple control groups (p < 0.05). Social work consultations were relatively infrequent across all groups, with no statistically significant differences. 4. Utilization of Functional and Long-Term Support Services Indicators of functional decline and long-term support service utilization were examined across all study groups at 30, 180, and 365 days following surgery (Table 4 ). Table 4 Functional Decline and Use of Long-Term Support Services Within One Year Post-Surgery by Study Group Intervention (N = 191) Control 1 (N = 348) Control 2 (N = 240) Control 3 (N = 601) Control 4 (N = 1,670) p-value Receiving a disability allowance from the National Insurance (% of patients) Within 30 days post-surgery 2.09 4.31 5.83 3.83 3.59 All not SS Within 180 days post-surgery 18.32 19.54 20.00 21.96 22.16 Within 365 days post-surgery 25.13 25.86 21.67 25.79 25.69 Transition to and/or admission to a nursing home (% of patients) Within 30 days post-surgery 1.05 3.74 4.17 2.66 2.04 All not SS Within 180 days post-surgery 4.71 11.21 9.17 5.99 4.79 C1 = 0.01 Within 365 days post-surgery 12.36 12.08 6.32 5.69 12.36 C1 = 0.03 Reimbursement under a private long-term care insurance policy (% of patients) Within 30 days post-surgery 0.52 1.72 2.08 0.50 0.54 All not SS Within 180 days post-surgery 4.19 5.75 7.92 4.83 4.31 Within 365 days post-surgery 6.28 6.90 8.75 5.82 4.91 Medical home care (% of patients) Within 30 days post-surgery 0.00 2.87 2.08 0.83 0.42 C1 = 0.02 Within 90 days post-surgery 0.00 5.46 4.17 3.16 1.98 C1, C2, C3 < 0.01 Within 140 days post-surgery 0.00 6.90 7.08 4.66 2.51 All < 0.01 Within 180 days post-surgery 0.00 8.33 7.50 4.83 2.87 All < 0.01 Within 365 days post-surgery 1.05 10.63 9.58 6.99 3.71 C1, C2, C3 < 0.01 Notes : "All not SS" indicates that no significant differences were found. In BOLD statistically significant results < 0.05. Control 1: Community-based multidisciplinary geriatric consultation; Control 2: Solo visit with a community geriatrician; Control 3: Basic preoperative assessments (visit by primary care physician or pharmacist-led medication review); Control 4: No geriatric-related care in the year prior to surgery. The proportion of patients receiving a disability allowance from the National Insurance was similar across all groups at one year, with rates ranging from 21.7% in Control 2 to 25.9% in Control 1. The intervention group had a comparable rate of 25.1%, and no statistically significant differences were observed between groups at any time point. Regarding transition to and/or admission to a nursing home, a significantly lower rate was observed in the intervention group compared to Control 1 at 180 days post-surgery (4.7% vs. 11.2%, p = 0.01). This difference persisted at one year (12.4% vs. 12.1%, p = 0.03). For reimbursement under a private long-term care insurance policy, the intervention group had a one-year rate of 6.3%, which was slightly lower than in Control 2 (8.8%) and similar to other controls. No statistically significant differences were found between groups. In terms of medical home care, the intervention group had the lowest utilization rates across all time points. At one year, only 1.05% of intervention patients received this service, compared to 10.6% in Control 1, 9.6% in Control 2, and 7.0% in Control 3 (p < 0.01 for all comparisons). No significant differences were observed relative to Control 4. 5. Healthcare Expenditures During the First Postoperative Year Mean monthly healthcare costs were assessed across study groups during two distinct periods: the first two months post-surgery and the full 12-month follow-up period. These expenditures represent total healthcare costs to the payer, including hospitalizations, medications, and outpatient care, as defined in the Methods. Detailed results are presented in Fig. 1 . In the immediate postoperative period (first two months), the intervention group demonstrated the lowest average monthly cost at 36,086 ILS. In comparison, Control 1 and Control 2 incurred significantly higher costs, at 62,174 ILS and 66,629 ILS, respectively. Control 3 and Control 4 also had higher expenditures than the intervention group during this period, at 45,688 ILS and 44,003 ILS, respectively. All comparisons with the intervention group were statistically significant ( p < 0.01). When examining the full 12-month period following surgery, the intervention group continued to show significantly lower average monthly costs (61,450 ILS) compared to all control groups. Specifically, monthly expenditures were 85,146 ILS in Control 1, 87,664 ILS in Control 2, 66,687 ILS in Control 3, and 59,498 ILS in Control 4. All differences were statistically significant ( p < 0.01) Discussion Our results show that patients who received structured, hospital-based PGA had significantly lower one-year mortality, fewer ED visits and hospital readmissions, and reduced use of home care and institutional services compared to controls. Overall healthcare costs were also lower, while primary care follow-up was better sustained. Even in outcomes where group differences did not reach statistical significance, such as postoperative cognitive decline, nutritional deterioration, or new functional impairments, the directionality of effects consistently favored the PGA group. These patterns may hold clinical relevance, especially considering the high baseline risk in this population and the cumulative impact of minor deteriorations on long-term independence. Outcomes varied by level and timing of geriatric input, highlighting the need for integrated preoperative assessments. However, when compared to Control Groups 1 and 2, who had prior community-based consultations, differences were often larger and statistically significant, particularly in mortality, acute care utilization, and medical home care. This may reflect the limitations of fragmented or delayed community interventions that are not fully integrated into the surgical planning process. By contrast, Control Groups 3 and 4 (representing minimal or absent geriatric contact) showed outcomes that more closely resembled the intervention group in certain domains, possibly due to overall better baseline health or fewer identified vulnerabilities. These patterns underscore the importance not only of having a geriatric assessment, but of ensuring its timing, structure, and clinical integration. These consistent patterns suggest that timely PGA can help mitigate frailty-related risks and system burden in real-world surgical pathways. Our findings align with and extend the existing body of evidence on the role of PGA. Prior studies have established that frailty is a predictor of poor surgical outcomes, including complications, prolonged hospitalization, and mortality 4 , 14 , 15 . Consistent with this, our study showed that PGA contributed to lower acute care utilization and mortality, reinforcing its value as a preoperative intervention. A recent meta-analysis further demonstrated that comprehensive geriatric care models are associated with reduced postoperative complications and improved recovery trajectories in older adults undergoing elective surgery 16 . More specifically, previous work has underscored the potential of PGA to guide perioperative planning and risk stratification 5 , 6 , 8 . Our study contributes a real-world validation of this concept within a system-level implementation and further differentiates between levels of geriatric input. Unlike most prior research, which dichotomized exposure to PGA, we examined a spectrum of geriatric care intensities and found that only structured, hospital-based PGA yielded consistent and significant benefits. This highlights the potential added value of embedding geriatric assessment within surgical workflows, rather than relying on fragmented or community-based evaluations 14 – 18 . This study has several limitations. First, because it is a retrospective analysis, causal inferences cannot be definitively established, although we attempted to reduce bias through matching and analytic adjustments. Second, patients were not randomly assigned to the geriatric assessment, and thus unmeasured confounders may have influenced group differences despite similar baseline characteristics. Third, there is some uncertainty regarding preoperative processes in the control hospitals. While the structured PGA at Assuta was standardized and documented, some control patients may have received limited geriatric input during hospital-based surgical clearance. To the best of our knowledge, no comprehensive PGA protocols were in place in these hospitals. If such elements were present, they would likely bias results toward the null, making the observed differences in mortality and healthcare use conservative estimates of the intervention’s true effect. Fourth, the timing of geriatric input varied markedly across groups. The hospital-based PGA was delivered shortly before surgery as part of routine perioperative planning, whereas community-based consultations in the control groups occurred substantially earlier, on average, 189 days prior to surgery in Control Group 1, 167 days in Control Group 2, and 180 days in Control Group 3. This extended interval may have limited the clinical utility of community assessments and underscores the potential importance of proximity and integration of geriatric input into surgical workflows. Beyond differences in timing, the context in which the geriatric assessment was delivered may also have influenced its impact. The intervention group received PGA within a structured preoperative setting, often just days before surgery, which likely increased the salience and perceived urgency of the recommendations among patients, families, and surgical teams. In contrast, community-based consultations in the control groups may have occurred in less time-sensitive or lower-stakes clinical contexts, potentially reducing the likelihood that recommendations were acted upon. This contextual distinction may partly explain the observed differences in outcomes, independent of the assessment content itself. This hypothesis is supported by qualitative research showing that frail older adults perceive preoperative geriatric consultations as more actionable and motivating when conducted in the immediate surgical context, reinforcing adherence and shared decision-making 19 . Finally, some outcomes, particularly those related to functional decline and long-term service utilization, were derived from administrative registries (e.g., nursing home entry or disability benefits), rather than direct clinical assessments. These registry-based indicators often reflect delayed or formal documentation and may not capture subtle or early-stage clinical changes, which typically emerge over time or after repeated evaluations. This limitation may have contributed to the absence of statistically significant differences in certain morbidity indicators and reflects broader challenges in perioperative cognitive and functional monitoring, as recently described by Barreto Chang et al 20 . Despite these limitations, the study has multiple strengths. It is one of the largest real-world evaluations of preoperative geriatric assessment using integrated electronic health records over a one-year follow-up. The inclusion of a broad control cohort, stratified by degree of geriatric exposure, enabled nuanced comparison beyond binary intervention models. The use of cluster-based matching enhanced internal validity while preserving external generalizability. Furthermore, the analysis covered a wide range of outcomes, from mortality to health system costs, providing a comprehensive picture of the intervention’s impact. Although numerous studies have highlighted the importance of PGA for improving outcomes among older surgical patients, the current literature does not include direct comparisons between PGA and earlier geriatric assessment, such as during initial diagnosis or within primary care. Most research focuses on comparing PGA to standard care, consistently demonstrating benefits such as reduced postoperative complications, shorter hospital stays, and improved functional recovery 8 , 13 , 21 . However, studies directly examining the impact of the timing of geriatric assessment, specifically preoperative versus earlier assessment, on patient outcomes are lacking. This gap in the evidence highlights the need for further research to determine whether earlier implementation of geriatric assessment confers additional advantages beyond those achieved with preoperative assessment alone. In summary, this study offers real-world evidence suggesting that structured, hospital-based geriatric assessment prior to major elective surgery may be associated with improved clinical and economic outcomes in older adults. By comparing varying levels and settings of geriatric involvement, our findings indicate that not all forms of assessment appear to yield equivalent results, highlighting the potential value of timely, structured, and integrated preoperative geriatric care. While these results support further consideration of broader PGA implementation, future research is needed to clarify the mechanisms, optimal timing, and continuity of geriatric input across different surgical pathways. Abbreviations ADL Activities of Daily Living ASA American Society of Anesthesiologists ED Emergency Department GA Geriatric Assessment IADL Instrumental Activities of Daily Living LOS Length of Stay PGA Preoperative Geriatric Assessment Declarations Ethics approval and consent to participate The study was approved by the ethics committees of both Assuta Medical Centers (Approval #0031-23-ASMC) and Maccabi Healthcare Services (Approval #MHS-0079-23). The requirement for informed consent was waived due to the retrospective nature of the study and the exclusive use of de-identified administrative data. Consent for publication Not applicable. Availability of data and materials The datasets generated and/or analyzed during the current study are not publicly available due to institutional data sharing restrictions, but are available from the corresponding author on reasonable request. Competing interests The authors declare that they have no competing interests. Funding The study was funded by Kahn-Sagol-Maccabi (KSM), the research and innovation institute of Maccabi Healthcare Services. Author Contributions Reut Ron: study concept and design; data analysis and interpretation; manuscript preparation and critical revision. Hadar Goldstein: acquisition of data; data analysis and interpretation; manuscript preparation. Zorian Radomyslsky: study design; interpretation of data; manuscript review and edits. Acknowledgments The authors would like to thank the data and analytics teams at Assuta Medical Centers and Maccabi Healthcare Services for their support in data extraction and linkage. We are also grateful to Dr. Royi Barnea‏ for his assistance in managing the study process, and to Dr. Tal Patalon for her valuable input on the methodological approach. References Thillainadesan J, Scott IA, Le Couteur DG. Frailty, a multisystem ageing syndrome. Age Ageing . 2020;49(5):758-763. doi:10.1093/ageing/afaa112 McIsaac DI, Saunders C, Hladkowicz E, et al. PREHAB study: a protocol for a prospective randomised clinical trial of exercise therapy for people living with frailty having cancer surgery. BMJ Open . 2018;8(6):e022057. Published 2018 Jun 22. doi:10.1136/bmjopen-2018-022057 Pilotto A, Custodero C, Maggi S, Polidori MC, Veronese N, Ferrucci L. A multidimensional approach to frailty in older people. Ageing Res Rev . 2020;60:101047. doi:10.1016/j.arr.2020.101047Clegg et al., 2013; Dent E, Hanlon P, Sim M, et al. Recent developments in frailty identification, management, risk factors and prevention: A narrative review of leading journals in geriatrics and gerontology. Ageing Res Rev . 2023;91:102082. doi:10.1016/j.arr.2023.102082 Barnett, 2019 Pang CL, Gooneratne M, Partridge JSL. Preoperative assessment of the older patient. BJA Educ . 2021;21(8):314-320. doi:10.1016/j.bjae.2021.03.005 Oresanya LB, Lyons WL, Finlayson E. Preoperative assessment of the older patient: a narrative review. JAMA. 2014;311(20):2110-2120. doi:10.1001/jama.2014.4573 Shahab R, Lochrie N, Moppett IK, Dasgupta P, Partridge JSL, Dhesi JK. A Description of Interventions Prompted by Preoperative Comprehensive Geriatric Assessment and Optimization in Older Elective Noncardiac Surgical Patients. J Am Med Dir Assoc . 2022;23(12):1948-1954.e4. doi:10.1016/j.jamda.2022.08.009 Dossabhoy SS, Graham LA, Kashikar A, et al. Frailty and Long-Term Health Care Utilization After Elective General and Vascular Surgery. JAMA Surg . 2025;160(2):210-218. doi:10.1001/jamasurg.2024.5711 Dolin TG, Mikkelsen M, Jakobsen HL, et al. Geriatric assessment and intervention in older vulnerable patients undergoing surgery for colorectal cancer: a protocol for a randomised controlled trial (GEPOC trial). BMC Geriatr . 2021;21(1):88. Published 2021 Jan 30. doi:10.1186/s12877-021-02045-9 Makary MA, Segev DL, Pronovost PJ, et al. Frailty as a predictor of surgical outcomes in older patients. J Am Coll Surg . 2010;210(6):901-908. doi:10.1016/j.jamcollsurg.2010.01.028 Chen L, Zong W, Luo M, Yu H. The impact of comprehensive geriatric assessment on postoperative outcomes in elderly surgery: A systematic review and meta-analysis. PLoS One . 2024;19(8):e0306308. Published 2024 Aug 28. doi:10.1371/journal.pone.0306308 Blackberry I, Boak J, Rasekaba T, Steer C. Real-world implementation of geriatric assessment in cancer care among older adults: the role of implementation science frameworks. Curr Opin Support Palliat Care . 2025;19(1):12-18. doi:10.1097/SPC.0000000000000740 Steenblock J, Braisch U, Brefka S, et al. Frailty index and its association with the onset of postoperative delirium in older adults undergoing elective surgery. BMC Geriatr . 2023;23(1):90. Published 2023 Feb 11. doi:10.1186/s12877-022-03663-7 Gong S, Qian D, Riazi S, et al. Association Between the FRAIL Scale and Postoperative Complications in Older Surgical Patients: A Systematic Review and Meta-Analysis. Anesth Analg . 2023;136(2):251-261. doi:10.1213/ANE.0000000000006272 McIsaac DI, Taljaard M, Bryson GL, et al. Frailty as a Predictor of Death or New Disability After Surgery: A Prospective Cohort Study. Ann Surg . 2020;271(2):283-289. doi:10.1097/SLA.0000000000002967 Saripella A, Wasef S, Nagappa M, et al. Effects of comprehensive geriatric care models on postoperative outcomes in geriatric surgical patients: a systematic review and meta-analysis. BMC Anesthesiol . 2021;21(1):127. Published 2021 Apr 22. doi:10.1186/s12871-021-01337-2 Dong X, Zhang X, Hu F, Yang S, Hong Z, Geng Q. Association of frailty with adverse outcomes in surgically treated geriatric patients with hip fracture: A meta-analysis and trial sequential analysis. PLoS One . 2024;19(6):e0305706. Published 2024 Jun 21. doi:10.1371/journal.pone.0305706 STARSurg Collaborative; EuroSurg Collaborative. Association between multimorbidity and postoperative mortality in patients undergoing major surgery: a prospective study in 29 countries across Europe. Anaesthesia . 2024;79(9):945-956. doi:10.1111/anae.16324 Åhlund K, Larsson LG, Ekerstad N, Normann M, Prytz M, Johnsson A. Experiences of participating in a preoperative comprehensive geriatric assessment and care intervention among frail older adults before colorectal cancer resection surgery. BMC Geriatr . 2025;25(1):310. Published 2025 May 5. doi:10.1186/s12877-025-05922-9 Barreto Chang OL, Pawar N, Whitlock EL, Miller B, Possin KL. Gaps in cognitive care among older patients undergoing spine surgery. J Am Geriatr Soc . 2024;72(7):2133-2139. doi:10.1111/jgs.18843 Chang SY, Son J, Park SM, Chang BS, Lee CK, Kim H. Predictive Value of Comprehensive Geriatric Assessment on Early Postoperative Complications Following Lumbar Spinal Stenosis Surgery: A Prospective Cohort Study. Spine (Phila Pa 1976) . 2020;45(21):1498-1505. doi:10.1097/BRS.0000000000003597 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7262797","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":509942594,"identity":"cf76d66a-24b8-4164-9fd4-7e2ea1a1afd1","order_by":0,"name":"Reut Ron","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAwklEQVRIiWNgGAWjYPACGyQ2M3MDIeWMQBVpMAZICyNRWg4jaWEgoMW8vcf8cUXFeXn5/jPmD34w2MkxsBPQInPmjGHjmTO3DTfcyDFs7GFINiboMAkJoMrGttuMGyR4DBt4GA4kNhDUIv8GpOWc/fx+oHV/iNICNByoBajyQI5hM3G28KQVzmw4k5y84UZa4WwZg2RjNoJa2A9v+NhQYWc7vx/IeFNhJ8fPf/gAXi1owICBgY0U9aNgFIyCUTAKsAMAprxCaRXyFM8AAAAASUVORK5CYII=","orcid":"","institution":"Assuta Health Services Research Institute","correspondingAuthor":true,"prefix":"","firstName":"Reut","middleName":"","lastName":"Ron","suffix":""},{"id":509942595,"identity":"02536ff3-3a3e-47f9-9a18-280092e24956","order_by":1,"name":"Hadar Goldstein","email":"","orcid":"","institution":"Assuta Health Services Research Institute","correspondingAuthor":false,"prefix":"","firstName":"Hadar","middleName":"","lastName":"Goldstein","suffix":""},{"id":509942597,"identity":"c9377eda-25e9-4ce0-b056-5bcd5506dfb6","order_by":2,"name":"Zorian Radomyslsky","email":"","orcid":"","institution":"Maccabi Healthcare Services","correspondingAuthor":false,"prefix":"","firstName":"Zorian","middleName":"","lastName":"Radomyslsky","suffix":""}],"badges":[],"createdAt":"2025-07-31 13:38:14","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7262797/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7262797/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":90909606,"identity":"e580bd3d-268b-41ae-94d1-bfc58df615ad","added_by":"auto","created_at":"2025-09-09 13:31:27","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":16908,"visible":true,"origin":"","legend":"\u003cp\u003eMean Monthly Healthcare Cost by Study Group during Immediate Postoperative Period (First 2 Months) and Full 12-Month Follow-up.\u003c/p\u003e\n\u003cp\u003eThis figure shows the mean monthly healthcare expenditures (in Israeli Shekels, ILS) for the intervention group and four control groups of older adults undergoing elective major surgery. The orange bars represent the average monthly cost during the first two months post-surgery, while the red bars represent the average monthly cost for the entire 12-month postoperative follow-up. The intervention group received structured, hospital-based preoperative geriatric assessment (PGA); Control Groups 1 and 2 received varying levels of community-based geriatric consultation; Control Groups 3 and 4 received minimal or no preoperative geriatric care. Abbreviations: ILS, Israeli Shekel; PGA, Preoperative Geriatric Assessment.\u003c/p\u003e","description":"","filename":"Figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7262797/v1/08eec08c56cf304452b3a4b3.jpg"},{"id":95801488,"identity":"2ed88197-728c-4fbe-a3ee-84c4dfc20429","added_by":"auto","created_at":"2025-11-13 08:25:31","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1428987,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7262797/v1/4ae50894-71bb-4265-8829-24b87e55cac0.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Preoperative Geriatric Assessment Impact on Health Outcomes in Older Adults After Major Surgery A Retrospective Matched Study","fulltext":[{"header":"Key Points","content":"\u003ch3\u003e\u003cu\u003eKey Points\u003c/u\u003e\u003c/h3\u003e\n\u003cul\u003e\n \u003cli\u003eStructured, hospital-based preoperative geriatric assessment (PGA) was associated with lower one-year mortality and reduced healthcare utilization among older adults undergoing major elective surgery.\u003c/li\u003e\n \u003cli\u003ePatients receiving PGA showed lower rates of ED visits, hospitalizations, home care use, and institutionalization compared to matched controls.\u003c/li\u003e\n \u003cli\u003eFindings highlight the added value of integrating PGA within surgical pathways rather than relying solely on community-based or fragmented assessments.\u003c/li\u003e\n\u003c/ul\u003e\n\u003ch3\u003e\u003cu\u003eWhy does this paper matter?\u003c/u\u003e\u003c/h3\u003e\n\u003cp\u003eThis study provides real-world evidence supporting broader implementation of structured PGA to improve surgical outcomes and system-level efficiency for frail older adults.\u003c/p\u003e"},{"header":"Background","content":"\u003cp\u003eAs populations age, frailty has emerged as one of the key syndromes complicating surgical care for older adults. Frailty is a multidimensional syndrome with decreased physiological reserves and increased vulnerability, involving genetic, biological, functional, cognitive, psychological, and socio-economic factors\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e. Frailty is estimated to affect 10–15% of community-dwelling adults over age 65, and up to 25–50% among older adults undergoing major surgery \u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e–\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eManagement strategies and new frameworks for screening and treating frailty have emerged \u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e. Preoperative Geriatric Assessment (PGA) is a comprehensive, approach that evaluates frailty, nutrition, cognition, and function to optimize elderly patients before surgery. It involves assessing frailty, nutritional status, cognitive function, and functional capabilities \u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e–\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e. This assessment goes beyond standard preoperative evaluations by addressing geriatric syndromes and age-related physiological changes \u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e. The process aims to identify and mitigate potential risks, improve decision-making, and enhance postoperative outcomes \u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e,\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e, but often it is reserved for select high-risk patients rather than used systematically \u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eStudies have shown that PGA has emerged as a valuable tool for predicting postoperative outcomes and healthcare utilization in older adults undergoing major surgery. PGA can prompt various interventions, including medication changes, lifestyle advice, and individualized care plans \u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e. Frailty is associated with higher long-term healthcare utilization, including increased inpatient admissions, emergency department visits, and nursing home encounters for up to 24 months post-surgery \u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e. However, implementation remains limited due to time, cost, workforce shortages, and poor integration with surgical teams \u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eThis study aimed to evaluate whether a structured, hospital-based PGA prior to elective major surgery improves postoperative outcomes in elderly patients. To address this question, we conducted a retrospective matched case-control study at a major surgical center in Israel, where a structured geriatric assessment program was implemented as part of its routine preoperative workflow for older adults over age 65, comparing patients who underwent comprehensive GA with similar patients who did not receive such an assessment. This study examines the real-world impact of PGA on outcomes and utilization.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e The study used linked clinical and administrative datasets from Maccabi Healthcare Services and Assuta Medical Center (2019–2023), providing a comprehensive longitudinal view of each patient’s care trajectory. Eligible participants were adults ≥ 65 undergoing common elective orthopedic or abdominal surgeries with general or regional anesthesia, identified as high-volume procedures with frailty risk.\u003c/p\u003e\u003cp\u003eThe intervention group completed an Adapted Surgical Frailty Score covering comorbidities, function, cognition, nutrition, delirium risk, and falls. This approach builds on practical two-stage frailty assessments shown effective in older surgical populations by Hosler et al \u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e. Only fully assessed patients were included.\u003c/p\u003e\u003cp\u003eThe control group comprised 3,068 patients drawn from the national database of Maccabi, who underwent the same surgical procedures during the same period but did not receive a structured PGA at the hospital. Matching used a cluster-based approach by sex, surgery type, birth year, and socioeconomic status. For the purpose of this analysis, we focused on a subset of 191 patients who underwent one of the pre-specified orthopedic and abdominal procedures best aligned with available control group data.\u003c/p\u003e\u003cp\u003eBaseline covariates (age, sex, SES, comorbidities) showed no significant differences (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e), supporting adequate matching; multivariable modeling was not needed. Nevertheless, we recognize that statistical non-significance does not fully rule out residual confounding, and future studies should consider additional adjustment techniques such as propensity score matching or multivariable regression.\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eBaseline Demographic, Clinical, and Surgical Characteristics of the Study Population by Group\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIntervention (N = 191)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eControl 1 (N = 348)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eControl 2 (N = 240)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eControl 3 (N = 601)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eControl 4 (N = 1,670)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003ep-value vs. intervention\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge (mean ± SD)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e80.78\u003c/p\u003e\u003cp\u003e± 6.93\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e80.73\u003c/p\u003e\u003cp\u003e± 6.78\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e80.81\u003c/p\u003e\u003cp\u003e± 6.65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e81.01\u003c/p\u003e\u003cp\u003e± 7.12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e81.03\u003c/p\u003e\u003cp\u003e± 6.25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eAll not SS\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e53.93\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e63.51\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e61.67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e50.58\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e51.44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eC1 = 0.03\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSocioeconomic Status \u0026gt; 5 (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e64.41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e51.44\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e62.52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e66.39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e63.71\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eC1 \u0026lt; 0.01\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePreoperative Prevalence of\u003c/p\u003e\u003cp\u003eHealth Conditions in EMR registries (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFalling risk\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e98.43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e99.43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e99.17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e98.67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e97.19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eAll not SS\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCognitive impairment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e26.70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e54.60\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e55.00\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e25.46\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e24.91\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eC1, C2 \u0026lt; 0.01\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNutritional disorders\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e87.43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e93.10\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e94.58\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e90.85\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e89.52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eC1, C2 \u0026lt; 0.04\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSurgery type (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eKnee replacement\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e41.36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e22.41\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e22.50\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e45.76\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e44.25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"5\" rowspan=\"6\"\u003e\u003cp\u003eC1, C2 \u0026lt; 0.01\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHip replacement\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e25.65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e61.78\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e66.25\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e24.63\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e25.75\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBilateral hernia repair\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e16.75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e9.48\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e4.17\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e15.31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e14.07\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUnilateral hernia repair\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7.85\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e2.30\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e4.58\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e6.16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e7.19\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOther hernia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5.76\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e3.16\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e1.25\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4.99\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e7.19\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePO ventral hernia repair\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e0.86\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e1.25\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3.16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.56\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNotes\u003c/b\u003e: EMR = Electronic Medical Record;\u003c/p\u003e\u003cp\u003e\"All not SS\" indicates that no significant differences were found; In \u003cb\u003eBOLD\u003c/b\u003e statistically significant results \u0026lt; 0.05.\u003c/p\u003e\u003cp\u003eControl 1: Community-based multidisciplinary geriatric consultation; Control 2: Solo visit with a community geriatrician; Control 3: Basic preoperative assessments (visit by primary care physician or pharmacist-led medication review); Control 4: No geriatric-related care in the year prior to surgery.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e\u003cp\u003e To further refine the comparison and to examine potential gradations of geriatric input, the control group was internally stratified into four subgroups according to their documented exposure to geriatric-related healthcare services in the year preceding surgery:\u003c/p\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eControl Group 1\u003c/b\u003e - patients who underwent a multidisciplinary, community-based geriatric consultation.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eControl Group 2\u003c/b\u003e -patients who received a solo consultation with a community-based geriatrician.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eControl Group 3\u003c/b\u003e - patients who had minimal geriatric-oriented care, such as a clinical pharmacist deprescribing consultation or a structured primary care physician visit.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eControl Group 4\u003c/b\u003e - patients who had no recorded geriatric intervention.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003cp\u003eThis structure allowed evaluation of community-level alternatives to hospital-based PGA. Down-sampling improved comparability. Down-sampling was applied in larger groups to improve baseline comparability.\u003c/p\u003e\u003cp\u003eOutcomes included mortality and indicators of acute clinical deterioration, such as hospital readmissions and emergency department visits, markers of healthcare utilization and continuity of care and specialist follow-ups. Healthcare expenditures were calculated based on the total direct costs to the health plan, including inpatient care, emergency department visits, outpatient consultations, diagnostics, procedures, prescription medications, and long-term services. All values were estimated using standardized tariffs set by the Israeli Ministry of Health and Maccabi Healthcare Services.\u003c/p\u003e\u003cp\u003eAll data were analyzed using SPSS, R, and Microsoft Excel. Descriptive statistics were used to summarize the characteristics of the study population and to describe key outcome variables. Group comparisons were conducted using chi-square tests for categorical variables and t-tests or their non-parametric equivalents for continuous variables, depending on distributional assumptions. In instances where expected cell counts were low, Fisher’s exact test was applied instead of the chi-square test to ensure validity. Statistical significance was defined as a two-tailed p-value less than 0.05.\u003c/p\u003e\u003cp\u003e The study was approved by the ethics committees of both Assuta Medical Centers (Approval #0031-23-ASMC) and Maccabi Healthcare Services (Approval #MHS-0079-23). Data extraction, linkage, and statistical analyses were conducted in accordance with data protection regulations and patient confidentiality protocols. This manuscript was edited for language and style using a large language model (ChatGPT, OpenAI), under the supervision of the corresponding author. No LLM was involved in data analysis, interpretation, or the generation of original content.\u003c/p\u003e"},{"header":"Results","content":"\u003ch3\u003e1. Study Population Characteristics\u003c/h3\u003e\n\u003cp\u003eThe population included 3,050 patients ≥ 65 who underwent elective major surgery (2019–2023): 191 received structured hospital-based PGA, and 2,859 were grouped by prior geriatric care: multidisciplinary (Control 1, N = 348), solo geriatrician (Control 2, N = 240), minimal (Control 3, N = 601), or none (Control 4, N = 1,670).\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e presents the baseline demographic, clinical, and surgical characteristics of the study population. Mean age was ~ 81 years with no significant differences; gender and SES were similar, except for more women and lower SES in Control 1.\u003c/p\u003e\u003cp\u003eNearly all patients were flagged for fall risk with no group differences. Cognitive impairment and nutritional disorders were more common in Controls 1 and 2 (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e), indicating baseline differences in patient profiles. Knee replacements were more common in the intervention group, while Controls 1 and 2 had more hip replacements (significant differences).\u003c/p\u003e\u003cp\u003eIn summary, control Groups 3 and 4 (representing patients with minimal or no preoperative geriatric care) closely resembled the intervention group in terms of age, SES, gender, comorbidity profiles, and surgery types. In contrast, Control Groups 1 and 2, which included patients who had undergone more structured community-based geriatric assessments, differed more substantially from the intervention group on several key characteristics.\u003c/p\u003e\n\u003ch3\u003e2. Mortality and morbidity\u003c/h3\u003e\n\u003cp\u003eOne-year mortality following surgery was substantially lower in the intervention group (2.62%) compared to all control groups. The difference was statistically significant when compared to Control 1 (12.07%) and Control 2 (12.08%) (p \u0026lt; 0.01), as well as to Control 3 (6.99%) (p = 0.04). The comparison with Control 4 (5.39%) did not reach statistical significance (p = 0.14).\u003c/p\u003e\u003cp\u003eAcross all clinical status indicators, captured through registry entries indicating either a new diagnosis or a status update reflecting clinically significant morbidity, no statistically significant differences were observed between the intervention and control groups at 30, 180, or 365 days post-surgery. The full set of outcomes, including falling risk, cognitive impairment, nutritional disorders, bone disorders, and heart conditions, is detailed in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eRegistry entry or status update post-surgery\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIntervention (N = 191)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eControl 1 (N = 348)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eControl 2 (N = 240)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eControl 3 (N = 601)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eControl 4 (N = 1,670)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003ep-value vs. intervention\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFalling risk (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWithin 30 days post-surgery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4.19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.92\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5.99\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e5.27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eAll not SS\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWithin 180 days post-surgery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e13.61\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12.93\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e13.33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e16.47\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e13.61\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWithin 365 days post-surgery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e25.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e23.56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e20.42\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e24.29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e25.13\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCognitive impairment (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWithin 30 days post-surgery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.86\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.42\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eAll not SS\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWithin 180 days post-surgery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3.66\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5.75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5.42\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2.04\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWithin 365 days post-surgery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4.71\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7.18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8.75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3.49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3.59\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNutritional disorders (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWithin 30 days post-surgery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.57\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eAll not SS\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWithin 180 days post-surgery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9.95\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10.06\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8.75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e9.98\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e7.01\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWithin 365 days post-surgery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e15.18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18.39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e12.50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e15.47\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e12.99\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBone Disorders (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWithin 30 days post-surgery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.86\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.42\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.86\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eAll not SS\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWithin 180 days post-surgery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4.71\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7.92\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3.83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e4.61\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWithin 365 days post-surgery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6.81\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6.90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e12.50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e6.16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e5.87\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHeart Condition (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWithin 30 days post-surgery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.84\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eAll not SS\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWithin 180 days post-surgery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.57\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.87\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3.75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2.81\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWithin 365 days post-surgery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3.14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4.49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e4.85\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNotes\u003c/b\u003e: \"All not SS\" indicates that no significant differences were found.\u003c/p\u003e\u003cp\u003eControl 1: Community-based multidisciplinary geriatric consultation; Control 2: Solo visit with a community geriatrician; Control 3: Basic preoperative assessments (visit by primary care physician or pharmacist-led medication review); Control 4: No geriatric-related care in the year prior to surgery.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eFalling risk and other morbidity indicators showed no significant differences between groups (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). The proportion of patients with cognitive impairment at 365 days was 4.7% in the intervention group, compared to 7.2% in Control 1 and 8.8% in Control 2. Rates in Controls 3 and 4 were closer to those in the intervention group (3.5% and 3.6%, respectively), though the differences across groups did not reach significance.\u003c/p\u003e\u003cp\u003eNutritional disorders were recorded in 15.2% of intervention patients at one year, similar to Control 3 (15.5%) and lower than Control 1 (18.4%). Control 4 showed a somewhat lower rate (13.0%). Again, no significant group-level differences were identified. For bone disorders, the highest one-year rate was observed in Control 2 (12.5%), while the intervention group had a lower rate of 6.8%, comparable to other control groups. Heart conditions were infrequent across all groups. At 365 days, rates ranged from 3.1% in the intervention group to 5.0% in Control 2, without statistically significant differences. Overall, none of the registry-based indicators showed statistically significant variation between the intervention and control groups at any time point.\u003c/p\u003e\n\u003ch3\u003e3. ED visits, Hospitalizations and Healthcare Utilization\u003c/h3\u003e\n\u003cp\u003eDifferences in healthcare utilization and specialist consultations were observed between the intervention and control groups throughout the first year following surgery (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eHealthcare Utilization, and Specialist Visits During the First Year After Surgery by Study Group\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIntervention (N = 191)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eControl 1 (N = 348)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eControl 2 (N = 240)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eControl 3 (N = 601)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eControl 4 (N = 1,670)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003ep-value vs. intervention\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eED visits (% of patients with at least one visit)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWithin 30 days post-surgery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e15.18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e57.76\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e59.58\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e30.78\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e31.80\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eAll \u0026lt; 0.01\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWithin 180 days post-surgery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e31.94\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e66.09\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e65.83\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e41.76\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e40.06\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eAll \u0026lt; 0.05\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWithin 365 days post-surgery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e43.46\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e70.69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e70.42\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e49.58\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e46.53\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eC1, C2 \u0026lt; 0.01\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMean number of ED visits\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWithin 30 days post-surgery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e0.81\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e0.84\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.43\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e0.44\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eAll \u0026lt; 0.01\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWithin 180 days post-surgery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e1.27\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e1.25\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.76\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e0.68\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eAll \u0026lt; 0.05\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWithin 365 days post-surgery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e1.54\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e1.59\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e1.05\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eC1, C2, C3 \u0026lt; 0.03\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eMean number of hospitalizations\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWithin 30 days post-surgery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e1.87\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e1.92\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e1.46\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e1.48\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eAll \u0026lt; 0.01\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWithin 180 days post-surgery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e2.55\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e2.50\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e1.86\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e1.82\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eAll \u0026lt; 0.01\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWithin 365 days post-surgery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.71\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e2.92\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e2.82\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e2.17\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e2.07\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eAll \u0026lt; 0.01\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e\u003cp\u003eFamily physician visit (% of patients with at least one visit)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWithin 30 days post-surgery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e84.82\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e69.25\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e73.75\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e81.36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e73.59\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eC1, C2, C4 \u0026lt; 0.01\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWithin 180 days post-surgery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e98.43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e88.22\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e93.33\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e95.67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e93.89\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eC1, C2, C4 \u0026lt; 0.05\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWithin 365 days post-surgery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e98.95\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e89.08\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e93.75\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e96.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e94.85\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eC1, C2, C4 \u0026lt; 0.05\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e\u003cp\u003eGeriatrician consultation visit (% of patients with at least one visit)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWithin 30 days post-surgery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e6.90\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.58\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.96\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eC1 \u0026lt; 0.01\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWithin 180 days post-surgery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9.42\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e31.61\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e26.25\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e5.16\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e4.37\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eAll \u0026lt; 0.05\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWithin 365 days post-surgery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e39.94\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e34.17\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e8.82\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e7.01\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eC1, C2, C4 \u0026lt; 0.05\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e\u003cp\u003eGeneral surgery specialist consultation (% of patients with at least one visit)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWithin 30 days post-surgery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e23.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e12.64\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e7.08\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e21.80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e21.92\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eC1, C2 \u0026lt; 0.01\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWithin 180 days post-surgery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e36.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e19.93\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e17.08\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e32.28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e30.60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eC1, C2 \u0026lt; 0.01\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWithin 365 days post-surgery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e42.93\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e26.44\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e22.50\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e39.93\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e35.99\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eC1, C2 \u0026lt; 0.01\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e\u003cp\u003ePain specialist consultation (% of patients with at least one visit)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWithin 30 days post-surgery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.57\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e0.00\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e0.18\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eC1, C4 \u0026lt; 0.05\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWithin 180 days post-surgery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5.76\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.87\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e1.68\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eC4 \u0026lt; 0.01\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWithin 365 days post-surgery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7.85\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e2.92\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e3.83\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e3.23\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eC2, C3, C4 \u0026lt; 0.05\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e\u003cp\u003eSocial work consultation (% of patients with at least one visit)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWithin 30 days post-surgery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.72\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eAll not SS\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWithin 180 days post-surgery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3.99\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2.34\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWithin 365 days post-surgery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5.24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9.20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e9.58\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e6.99\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3.47\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNotes\u003c/b\u003e: ED = Emergency Department;\u003c/p\u003e\u003cp\u003e\"All not SS\" indicates that no significant differences were found. In \u003cb\u003eBOLD\u003c/b\u003e statistically significant results \u0026lt; 0.05.\u003c/p\u003e\u003cp\u003eControl 1: Community-based multidisciplinary geriatric consultation; Control 2: Solo visit with a community geriatrician; Control 3: Basic preoperative assessments (visit by primary care physician or pharmacist-led medication review); Control 4: No geriatric-related care in the year prior to surgery.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003ePatients in the intervention group had lower rates of emergency department (ED) visits at all time points. Within 30 days post-surgery, 15.2% had at least one ED visit, compared to 57.8% in Control 1 and 59.6% in Control 2 (p \u0026lt; 0.01). This trend continued throughout the year, with consistently fewer ED visits and hospitalizations in the intervention group. (p \u0026lt; 0.01). Family physician and surgery specialist visits were more frequent in the intervention group, while geriatrician consultations were lower. (p \u0026lt; 0.01).\u003c/p\u003e\u003cp\u003eDifferences were also noted in pain specialist consultations, with the intervention group having a higher proportion of patients seen at 365 days (7.85%) compared to multiple control groups (p \u0026lt; 0.05). Social work consultations were relatively infrequent across all groups, with no statistically significant differences.\u003c/p\u003e\n\u003ch3\u003e4. Utilization of Functional and Long-Term Support Services\u003c/h3\u003e\n\u003cp\u003eIndicators of functional decline and long-term support service utilization were examined across all study groups at 30, 180, and 365 days following surgery (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eFunctional Decline and Use of Long-Term Support Services Within One Year Post-Surgery by Study Group\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"8\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIntervention (N = 191)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eControl 1 (N = 348)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eControl 2 (N = 240)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eControl 3 (N = 601)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003eControl 4 (N = 1,670)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e\u003cp\u003eReceiving a disability allowance from the National Insurance (% of patients)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWithin 30 days post-surgery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.09\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5.83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3.83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3.59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" morerows=\"2\" nameend=\"c8\" namest=\"c7\" rowspan=\"3\"\u003e\u003cp\u003eAll not SS\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWithin 180 days post-surgery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e18.32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e19.54\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e20.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e21.96\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e22.16\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWithin 365 days post-surgery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e25.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e25.86\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e21.67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e25.79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e25.69\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e\u003cp\u003eTransition to and/or admission to a nursing home (% of patients)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWithin 30 days post-surgery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.74\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.66\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003eAll not SS\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWithin 180 days post-surgery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4.71\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e11.21\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e9.17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5.99\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e4.79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003eC1 = 0.01\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWithin 365 days post-surgery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12.36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e12.08\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6.32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5.69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e12.36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003eC1 = 0.03\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e\u003cp\u003eReimbursement under a private long-term care insurance policy (% of patients)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWithin 30 days post-surgery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.72\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.54\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" morerows=\"2\" nameend=\"c8\" namest=\"c7\" rowspan=\"3\"\u003e\u003cp\u003eAll not SS\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWithin 180 days post-surgery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4.19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5.75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7.92\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4.83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e4.31\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWithin 365 days post-surgery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6.28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6.90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8.75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5.82\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e4.91\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e\u003cp\u003eMedical home care (% of patients)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWithin 30 days post-surgery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e2.87\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.42\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003eC1 = 0.02\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWithin 90 days post-surgery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e5.46\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e4.17\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e3.16\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.98\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003eC1, C2, C3 \u0026lt; 0.01\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWithin 140 days post-surgery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e6.90\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e7.08\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e4.66\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e2.51\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003eAll \u0026lt; 0.01\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWithin 180 days post-surgery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e8.33\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e7.50\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e4.83\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e2.87\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003eAll \u0026lt; 0.01\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWithin 365 days post-surgery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e10.63\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e9.58\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e6.99\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3.71\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003eC1, C2, C3 \u0026lt; 0.01\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNotes\u003c/b\u003e: \"All not SS\" indicates that no significant differences were found. In \u003cb\u003eBOLD\u003c/b\u003e statistically significant results \u0026lt; 0.05.\u003c/p\u003e\u003cp\u003eControl 1: Community-based multidisciplinary geriatric consultation; Control 2: Solo visit with a community geriatrician; Control 3: Basic preoperative assessments (visit by primary care physician or pharmacist-led medication review); Control 4: No geriatric-related care in the year prior to surgery.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eThe proportion of patients receiving a disability allowance from the National Insurance was similar across all groups at one year, with rates ranging from 21.7% in Control 2 to 25.9% in Control 1. The intervention group had a comparable rate of 25.1%, and no statistically significant differences were observed between groups at any time point.\u003c/p\u003e\u003cp\u003eRegarding transition to and/or admission to a nursing home, a significantly lower rate was observed in the intervention group compared to Control 1 at 180 days post-surgery (4.7% vs. 11.2%, p = 0.01). This difference persisted at one year (12.4% vs. 12.1%, p = 0.03).\u003c/p\u003e\u003cp\u003eFor reimbursement under a private long-term care insurance policy, the intervention group had a one-year rate of 6.3%, which was slightly lower than in Control 2 (8.8%) and similar to other controls. No statistically significant differences were found between groups.\u003c/p\u003e\u003cp\u003eIn terms of medical home care, the intervention group had the lowest utilization rates across all time points. At one year, only 1.05% of intervention patients received this service, compared to 10.6% in Control 1, 9.6% in Control 2, and 7.0% in Control 3 (p \u0026lt; 0.01 for all comparisons). No significant differences were observed relative to Control 4.\u003c/p\u003e\n\u003ch3\u003e5. Healthcare Expenditures During the First Postoperative Year\u003c/h3\u003e\n\u003cp\u003eMean monthly healthcare costs were assessed across study groups during two distinct periods: the first two months post-surgery and the full 12-month follow-up period. These expenditures represent total healthcare costs to the payer, including hospitalizations, medications, and outpatient care, as defined in the Methods. Detailed results are presented in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eIn the immediate postoperative period (first two months), the intervention group demonstrated the lowest average monthly cost at 36,086 ILS. In comparison, Control 1 and Control 2 incurred significantly higher costs, at 62,174 ILS and 66,629 ILS, respectively. Control 3 and Control 4 also had higher expenditures than the intervention group during this period, at 45,688 ILS and 44,003 ILS, respectively. All comparisons with the intervention group were statistically significant (\u003cem\u003ep\u003c/em\u003e \u0026lt; 0.01).\u003c/p\u003e\u003cp\u003eWhen examining the full 12-month period following surgery, the intervention group continued to show significantly lower average monthly costs (61,450 ILS) compared to all control groups. Specifically, monthly expenditures were 85,146 ILS in Control 1, 87,664 ILS in Control 2, 66,687 ILS in Control 3, and 59,498 ILS in Control 4. All differences were statistically significant (\u003cem\u003ep\u003c/em\u003e \u0026lt; 0.01)\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003e Our results show that patients who received structured, hospital-based PGA had significantly lower one-year mortality, fewer ED visits and hospital readmissions, and reduced use of home care and institutional services compared to controls. Overall healthcare costs were also lower, while primary care follow-up was better sustained. Even in outcomes where group differences did not reach statistical significance, such as postoperative cognitive decline, nutritional deterioration, or new functional impairments, the directionality of effects consistently favored the PGA group. These patterns may hold clinical relevance, especially considering the high baseline risk in this population and the cumulative impact of minor deteriorations on long-term independence.\u003c/p\u003e\u003cp\u003eOutcomes varied by level and timing of geriatric input, highlighting the need for integrated preoperative assessments. However, when compared to Control Groups 1 and 2, who had prior community-based consultations, differences were often larger and statistically significant, particularly in mortality, acute care utilization, and medical home care. This may reflect the limitations of fragmented or delayed community interventions that are not fully integrated into the surgical planning process.\u003c/p\u003e\u003cp\u003eBy contrast, Control Groups 3 and 4 (representing minimal or absent geriatric contact) showed outcomes that more closely resembled the intervention group in certain domains, possibly due to overall better baseline health or fewer identified vulnerabilities. These patterns underscore the importance not only of \u003cem\u003ehaving\u003c/em\u003e a geriatric assessment, but of ensuring its timing, structure, and clinical integration. These consistent patterns suggest that timely PGA can help mitigate frailty-related risks and system burden in real-world surgical pathways.\u003c/p\u003e\u003cp\u003eOur findings align with and extend the existing body of evidence on the role of PGA. Prior studies have established that frailty is a predictor of poor surgical outcomes, including complications, prolonged hospitalization, and mortality \u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e,\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e,\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e. Consistent with this, our study showed that PGA contributed to lower acute care utilization and mortality, reinforcing its value as a preoperative intervention. A recent meta-analysis further demonstrated that comprehensive geriatric care models are associated with reduced postoperative complications and improved recovery trajectories in older adults undergoing elective surgery\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eMore specifically, previous work has underscored the potential of PGA to guide perioperative planning and risk stratification \u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e,\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e,\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e. Our study contributes a real-world validation of this concept within a system-level implementation and further differentiates between levels of geriatric input. Unlike most prior research, which dichotomized exposure to PGA, we examined a spectrum of geriatric care intensities and found that only structured, hospital-based PGA yielded consistent and significant benefits. This highlights the potential added value of embedding geriatric assessment within surgical workflows, rather than relying on fragmented or community-based evaluations \u003csup\u003e\u003cspan additionalcitationids=\"CR15 CR16 CR17\" citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e–\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eThis study has several limitations. First, because it is a retrospective analysis, causal inferences cannot be definitively established, although we attempted to reduce bias through matching and analytic adjustments. Second, patients were not randomly assigned to the geriatric assessment, and thus unmeasured confounders may have influenced group differences despite similar baseline characteristics.\u003c/p\u003e\u003cp\u003eThird, there is some uncertainty regarding preoperative processes in the control hospitals. While the structured PGA at Assuta was standardized and documented, some control patients may have received limited geriatric input during hospital-based surgical clearance. To the best of our knowledge, no comprehensive PGA protocols were in place in these hospitals. If such elements were present, they would likely bias results toward the null, making the observed differences in mortality and healthcare use conservative estimates of the intervention’s true effect.\u003c/p\u003e\u003cp\u003eFourth, the timing of geriatric input varied markedly across groups. The hospital-based PGA was delivered shortly before surgery as part of routine perioperative planning, whereas community-based consultations in the control groups occurred substantially earlier, on average, 189 days prior to surgery in Control Group 1, 167 days in Control Group 2, and 180 days in Control Group 3. This extended interval may have limited the clinical utility of community assessments and underscores the potential importance of proximity and integration of geriatric input into surgical workflows.\u003c/p\u003e\u003cp\u003eBeyond differences in timing, the context in which the geriatric assessment was delivered may also have influenced its impact. The intervention group received PGA within a structured preoperative setting, often just days before surgery, which likely increased the salience and perceived urgency of the recommendations among patients, families, and surgical teams. In contrast, community-based consultations in the control groups may have occurred in less time-sensitive or lower-stakes clinical contexts, potentially reducing the likelihood that recommendations were acted upon. This contextual distinction may partly explain the observed differences in outcomes, independent of the assessment content itself. This hypothesis is supported by qualitative research showing that frail older adults perceive preoperative geriatric consultations as more actionable and motivating when conducted in the immediate surgical context, reinforcing adherence and shared decision-making \u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eFinally, some outcomes, particularly those related to functional decline and long-term service utilization, were derived from administrative registries (e.g., nursing home entry or disability benefits), rather than direct clinical assessments. These registry-based indicators often reflect delayed or formal documentation and may not capture subtle or early-stage clinical changes, which typically emerge over time or after repeated evaluations. This limitation may have contributed to the absence of statistically significant differences in certain morbidity indicators and reflects broader challenges in perioperative cognitive and functional monitoring, as recently described by Barreto Chang et al \u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eDespite these limitations, the study has multiple strengths. It is one of the largest real-world evaluations of preoperative geriatric assessment using integrated electronic health records over a one-year follow-up. The inclusion of a broad control cohort, stratified by degree of geriatric exposure, enabled nuanced comparison beyond binary intervention models. The use of cluster-based matching enhanced internal validity while preserving external generalizability. Furthermore, the analysis covered a wide range of outcomes, from mortality to health system costs, providing a comprehensive picture of the intervention’s impact.\u003c/p\u003e\u003cp\u003e Although numerous studies have highlighted the importance of PGA for improving outcomes among older surgical patients, the current literature does not include direct comparisons between PGA and earlier geriatric assessment, such as during initial diagnosis or within primary care. Most research focuses on comparing PGA to standard care, consistently demonstrating benefits such as reduced postoperative complications, shorter hospital stays, and improved functional recovery \u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e,\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e,\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e. However, studies directly examining the impact of the timing of geriatric assessment, specifically preoperative versus earlier assessment, on patient outcomes are lacking. This gap in the evidence highlights the need for further research to determine whether earlier implementation of geriatric assessment confers additional advantages beyond those achieved with preoperative assessment alone.\u003c/p\u003e\u003cp\u003eIn summary, this study offers real-world evidence suggesting that structured, hospital-based geriatric assessment prior to major elective surgery may be associated with improved clinical and economic outcomes in older adults. By comparing varying levels and settings of geriatric involvement, our findings indicate that not all forms of assessment appear to yield equivalent results, highlighting the potential value of timely, structured, and integrated preoperative geriatric care. While these results support further consideration of broader PGA implementation, future research is needed to clarify the mechanisms, optimal timing, and continuity of geriatric input across different surgical pathways.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eADL\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eActivities of Daily Living\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eASA\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eAmerican Society of Anesthesiologists\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eED\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eEmergency Department\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eGA\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eGeriatric Assessment\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eIADL\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eInstrumental Activities of Daily Living\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eLOS\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eLength of Stay\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003ePGA\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003ePreoperative Geriatric Assessment\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003ch3\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/h3\u003e\n\u003cp\u003eThe study was approved by the ethics committees of both Assuta Medical Centers (Approval #0031-23-ASMC) and Maccabi Healthcare Services (Approval #MHS-0079-23). The requirement for informed consent was waived due to the retrospective nature of the study and the exclusive use of de-identified administrative data.\u003c/p\u003e\n\u003ch3\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/h3\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003ch3\u003e\u003cstrong\u003eAvailability of data and materials\u0026nbsp;\u003c/strong\u003e\u003c/h3\u003e\n\u003cp\u003eThe datasets generated and/or analyzed during the current study are not publicly available due to institutional data sharing restrictions, but are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003ch3\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/h3\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003ch3\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/h3\u003e\n\u003cp\u003eThe study was funded by Kahn-Sagol-Maccabi (KSM), the research and innovation institute of Maccabi Healthcare Services.\u0026nbsp;\u003c/p\u003e\n\u003ch3\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/h3\u003e\n\u003cp\u003eReut Ron: study concept and design; data analysis and interpretation; manuscript preparation and critical revision.\u003c/p\u003e\n\u003cp\u003eHadar Goldstein: acquisition of data; data analysis and interpretation; manuscript preparation.\u003c/p\u003e\n\u003cp\u003eZorian Radomyslsky: study design; interpretation of data; manuscript review and edits.\u003c/p\u003e\n\u003ch3\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/h3\u003e\n\u003cp\u003eThe authors would like to thank the data and analytics teams at Assuta Medical Centers and Maccabi Healthcare Services for their support in data extraction and linkage. We are also grateful to Dr. Royi Barnea\u0026rlm; for his assistance in managing the study process, and to Dr. Tal Patalon for her valuable input on the methodological approach.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eThillainadesan J, Scott IA, Le Couteur DG. Frailty, a multisystem ageing syndrome. \u003cem\u003eAge Ageing\u003c/em\u003e. 2020;49(5):758-763. doi:10.1093/ageing/afaa112\u003c/li\u003e\n\u003cli\u003eMcIsaac DI, Saunders C, Hladkowicz E, et al. PREHAB study: a protocol for a prospective randomised clinical trial of exercise therapy for people living with frailty having cancer surgery. \u003cem\u003eBMJ Open\u003c/em\u003e. 2018;8(6):e022057. Published 2018 Jun 22. doi:10.1136/bmjopen-2018-022057 \u003c/li\u003e\n\u003cli\u003ePilotto A, Custodero C, Maggi S, Polidori MC, Veronese N, Ferrucci L. A multidimensional approach to frailty in older people. \u003cem\u003eAgeing Res Rev\u003c/em\u003e. 2020;60:101047. doi:10.1016/j.arr.2020.101047Clegg et al., 2013; \u003c/li\u003e\n\u003cli\u003eDent E, Hanlon P, Sim M, et al. Recent developments in frailty identification, management, risk factors and prevention: A narrative review of leading journals in geriatrics and gerontology. \u003cem\u003eAgeing Res Rev\u003c/em\u003e. 2023;91:102082. doi:10.1016/j.arr.2023.102082 Barnett, 2019\u003c/li\u003e\n\u003cli\u003ePang CL, Gooneratne M, Partridge JSL. Preoperative assessment of the older patient. \u003cem\u003eBJA Educ\u003c/em\u003e. 2021;21(8):314-320. doi:10.1016/j.bjae.2021.03.005\u003c/li\u003e\n\u003cli\u003eOresanya LB, Lyons WL, Finlayson E. Preoperative assessment of the older patient: a narrative review. JAMA. 2014;311(20):2110-2120. doi:10.1001/jama.2014.4573\u003c/li\u003e\n\u003cli\u003eShahab R, Lochrie N, Moppett IK, Dasgupta P, Partridge JSL, Dhesi JK. A Description of Interventions Prompted by Preoperative Comprehensive Geriatric Assessment and Optimization in Older Elective Noncardiac Surgical Patients. \u003cem\u003eJ Am Med Dir Assoc\u003c/em\u003e. 2022;23(12):1948-1954.e4. doi:10.1016/j.jamda.2022.08.009\u003c/li\u003e\n\u003cli\u003eDossabhoy SS, Graham LA, Kashikar A, et al. Frailty and Long-Term Health Care Utilization After Elective General and Vascular Surgery. \u003cem\u003eJAMA Surg\u003c/em\u003e. 2025;160(2):210-218. doi:10.1001/jamasurg.2024.5711\u003c/li\u003e\n\u003cli\u003eDolin TG, Mikkelsen M, Jakobsen HL, et al. Geriatric assessment and intervention in older vulnerable patients undergoing surgery for colorectal cancer: a protocol for a randomised controlled trial (GEPOC trial). \u003cem\u003eBMC Geriatr\u003c/em\u003e. 2021;21(1):88. Published 2021 Jan 30. doi:10.1186/s12877-021-02045-9\u003c/li\u003e\n\u003cli\u003eMakary MA, Segev DL, Pronovost PJ, et al. Frailty as a predictor of surgical outcomes in older patients. \u003cem\u003eJ Am Coll Surg\u003c/em\u003e. 2010;210(6):901-908. doi:10.1016/j.jamcollsurg.2010.01.028\u003c/li\u003e\n\u003cli\u003eChen L, Zong W, Luo M, Yu H. The impact of comprehensive geriatric assessment on postoperative outcomes in elderly surgery: A systematic review and meta-analysis. \u003cem\u003ePLoS One\u003c/em\u003e. 2024;19(8):e0306308. Published 2024 Aug 28. doi:10.1371/journal.pone.0306308\u003c/li\u003e\n\u003cli\u003eBlackberry I, Boak J, Rasekaba T, Steer C. Real-world implementation of geriatric assessment in cancer care among older adults: the role of implementation science frameworks. \u003cem\u003eCurr Opin Support Palliat Care\u003c/em\u003e. 2025;19(1):12-18. doi:10.1097/SPC.0000000000000740\u003c/li\u003e\n\u003cli\u003eSteenblock J, Braisch U, Brefka S, et al. Frailty index and its association with the onset of postoperative delirium in older adults undergoing elective surgery. \u003cem\u003eBMC Geriatr\u003c/em\u003e. 2023;23(1):90. Published 2023 Feb 11. doi:10.1186/s12877-022-03663-7\u003c/li\u003e\n\u003cli\u003eGong S, Qian D, Riazi S, et al. Association Between the FRAIL Scale and Postoperative Complications in Older Surgical Patients: A Systematic Review and Meta-Analysis. \u003cem\u003eAnesth Analg\u003c/em\u003e. 2023;136(2):251-261. doi:10.1213/ANE.0000000000006272\u003c/li\u003e\n\u003cli\u003eMcIsaac DI, Taljaard M, Bryson GL, et al. Frailty as a Predictor of Death or New Disability After Surgery: A Prospective Cohort Study. \u003cem\u003eAnn Surg\u003c/em\u003e. 2020;271(2):283-289. doi:10.1097/SLA.0000000000002967\u003c/li\u003e\n\u003cli\u003eSaripella A, Wasef S, Nagappa M, et al. Effects of comprehensive geriatric care models on postoperative outcomes in geriatric surgical patients: a systematic review and meta-analysis. \u003cem\u003eBMC Anesthesiol\u003c/em\u003e. 2021;21(1):127. Published 2021 Apr 22. doi:10.1186/s12871-021-01337-2\u003c/li\u003e\n\u003cli\u003eDong X, Zhang X, Hu F, Yang S, Hong Z, Geng Q. Association of frailty with adverse outcomes in surgically treated geriatric patients with hip fracture: A meta-analysis and trial sequential analysis. \u003cem\u003ePLoS One\u003c/em\u003e. 2024;19(6):e0305706. Published 2024 Jun 21. doi:10.1371/journal.pone.0305706\u003c/li\u003e\n\u003cli\u003eSTARSurg Collaborative; EuroSurg Collaborative. Association between multimorbidity and postoperative mortality in patients undergoing major surgery: a prospective study in 29 countries across Europe. \u003cem\u003eAnaesthesia\u003c/em\u003e. 2024;79(9):945-956. doi:10.1111/anae.16324\u003c/li\u003e\n\u003cli\u003e\u0026Aring;hlund K, Larsson LG, Ekerstad N, Normann M, Prytz M, Johnsson A. Experiences of participating in a preoperative comprehensive geriatric assessment and care intervention among frail older adults before colorectal cancer resection surgery. \u003cem\u003eBMC Geriatr\u003c/em\u003e. 2025;25(1):310. Published 2025 May 5. doi:10.1186/s12877-025-05922-9\u003c/li\u003e\n\u003cli\u003eBarreto Chang OL, Pawar N, Whitlock EL, Miller B, Possin KL. Gaps in cognitive care among older patients undergoing spine surgery. \u003cem\u003eJ Am Geriatr Soc\u003c/em\u003e. 2024;72(7):2133-2139. doi:10.1111/jgs.18843\u003c/li\u003e\n\u003cli\u003eChang SY, Son J, Park SM, Chang BS, Lee CK, Kim H. Predictive Value of Comprehensive Geriatric Assessment on Early Postoperative Complications Following Lumbar Spinal Stenosis Surgery: A Prospective Cohort Study. \u003cem\u003eSpine (Phila Pa 1976)\u003c/em\u003e. 2020;45(21):1498-1505. doi:10.1097/BRS.0000000000003597\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Preoperative geriatric assessment, frailty, surgical outcomes, older adults, healthcare utilization","lastPublishedDoi":"10.21203/rs.3.rs-7262797/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7262797/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eFrailty 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.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eParticipants and Setting:\u003c/strong\u003e Adults ≥65 insured by Maccabi Healthcare Services (Israel) who underwent specified elective orthopedic or abdominal surgeries at Assuta Medical Center between 2019–2023.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eThis 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.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003ePGA was associated with significantly lower one-year mortality (2.6% vs. up to 12% in some controls, p\u0026lt;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.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e 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.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTrial registration:\u003c/strong\u003eThis study was not registered in a clinical trial registry.\u003c/p\u003e","manuscriptTitle":"Preoperative Geriatric Assessment Impact on Health Outcomes in Older Adults After Major Surgery A Retrospective Matched Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-09 13:31:21","doi":"10.21203/rs.3.rs-7262797/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"1126543d-3f37-4828-91da-6b6547ae4e15","owner":[],"postedDate":"September 9th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-11-30T21:23:16+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-09 13:31:21","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7262797","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7262797","identity":"rs-7262797","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}