Relationship of the pre-operative comprehensive geriatric assessment to length of stay in Korean older adults undergoing spinal surgery

Background:: Although pre-operative, Comprehensive Geriatric Assessment has been used widely, its impact on the health status of older adults has not been fully examined. Aims:: This study aimed to investigate the relationships between subcomponents of a Comprehensive Geriatric Assessment and length of hospital stay in older adults undergoing spinal surgery. Methods:: Participants were 133 older adults in neurosurgical department. The Comprehensive Geriatric Assessment included nutrition, physical activity, functional status, cognition, depression, the Timed Up and Go test, self-rated health, and frailty. Length of stay was replaced by excessive number of days, because expected length of stay varied depending on the type of surgery. Results:: Excessive lengths of stay were associated with pre-frailty (p = 0.02), frailty (p = 0.02), risk of depression (p < 0.01), and post-operative complications (p < 0.01). More specifically, frailty and risk of depression played as moderators as interacting post-operative complications. The effect of interaction was greatest in the older adults who were frail and depressed (p < 0.001). Discussion:: Among the subcomponent of Comprehensive Geriatric Assessment, frailty and depression were significant predictors of excessive length of stay. The interrelationship between frailty and depression better explained excessive length of stay rather than considered as individual variable. Conclusions:: Clinicians are encouraged to pay attention to depression and frailty, and its interaction to improve the health status of surgical elderly patients.