{"entity":{"id":"idea-acc-geriatric-co-management-surgery","kind":"idea","name":"Geriatrician co-management for older patients having cancer surgery","aka":[],"tldr":"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.","asOf":"2026-09-08","links":[{"label":"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)","url":"https://doi.org/10.1016/S0140-6736(21)01789-X"}],"tags":[],"related":[],"cancers":[],"sections":["surgery"],"technologies":["geriatric-assessment"],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":["b-aging-comorbidity","b-surgery-radiation-innovation"],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"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.","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","cost":"medium","horizonYears":2},"route":"/ideas/idea-acc-geriatric-co-management-surgery/","neighbours":{"section":[{"id":"surgery","kind":"section","name":"Surgery & Interventional","route":"/fronts/surgery/"}],"technology":[{"id":"geriatric-assessment","kind":"technology","name":"Geriatric assessment","route":"/technologies/geriatric-assessment/"}],"bottleneck":[{"id":"b-aging-comorbidity","kind":"bottleneck","name":"Older and multimorbid patients are excluded and undertreated","route":"/bottlenecks/b-aging-comorbidity/"},{"id":"b-surgery-radiation-innovation","kind":"bottleneck","name":"Surgery and radiotherapy cure most, get least","route":"/bottlenecks/b-surgery-radiation-innovation/"}],"roadmap":[{"id":"surgery-roadmap","kind":"roadmap","name":"Surgery roadmap: radical operations → less surgery → no surgery when a drug has done the work","route":"/roadmaps/surgery-roadmap/"}]}}