# Geriatrician co-management for older patients having cancer surgery

Source: https://onco.cc/ideas/idea-acc-geriatric-co-management-surgery/  
OnCo record `idea-acc-geriatric-co-management-surgery` (Idea). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

When a geriatrician co-manages patients over 75 around a cancer operation, as in the POSH programme at Duke and POPS in the UK, complications, delirium, length of stay and readmissions fall. Preoperative optimisation and postoperative geriatric review should be a standard part of surgical oncology pathways for this age group.

## Summary

Perioperative geriatric co-management models (POSH at Duke, POPS in the UK) have shown reductions in complications, delirium, length of stay, and readmissions for older surgical patients. Cancer surgery in the over-75s is increasing and is where these gains are largest. Making co-management a standard component of surgical oncology pathways, with preoperative optimisation and postoperative geriatric review, is an organisational change with strong evidence.

## Fields

- Kind: Idea
- Last checked: 2026-09-08
- Hypothesis: Co-management will reduce postoperative complications and delirium by at least 25% and length of stay by two days in patients over 75 having major cancer surgery.
- Rationale: The evidence base is consistent across settings; the barrier is geriatrician availability and funding, both of which can be addressed by shared roles and payment.
- Proposed test: A stepped-wedge implementation across ten surgical oncology units with complications, delirium, length of stay, readmission, and functional recovery as endpoints.
- Maturity: being-tested-at-scale
- Actor: clinic

## Sources

- Bottleneck evidence (Older and multimorbid patients are excluded and undertreated): Mohile et al., Evaluation of geriatric assessment and management on toxic effects of cancer treatment (GAP70+, Lancet 2021): https://doi.org/10.1016/S0140-6736(21)01789-X

## Connected records

- fronts: [Surgery & Interventional](https://onco.cc/fronts/surgery/)
- technologies: [Geriatric assessment](https://onco.cc/technologies/geriatric-assessment/)
- bottlenecks: [Older and multimorbid patients are excluded and undertreated](https://onco.cc/bottlenecks/b-aging-comorbidity/), [Surgery and radiotherapy cure most, get least](https://onco.cc/bottlenecks/b-surgery-radiation-innovation/)
- roadmaps: [Surgery roadmap: radical operations → less surgery → no surgery when a drug has done the work](https://onco.cc/roadmaps/surgery-roadmap/)

---
JSON: https://onco.cc/api/v1/entities/idea-acc-geriatric-co-management-surgery.json