• Julia R Berian, Ronnie A Rosenthal, Tracey L Baker, JoAnn Coleman, Emily Finlayson, Mark R Katlic, Sandhya A Lagoo-Deenadayalan, Victoria L Tang, Thomas N Robinson, Clifford Y Ko, and Marcia M Russell.
• American College of Surgeons, Division of Research and Optimal Patient Care, Chicago, IL.
• Ann. Surg. 2018 Feb 1; 267 (2): 280-290.

ObjectiveThe aim of this study was to establish high-quality, valid standards to improve surgical care of the older adult.BackgroundThe aging population increases demand for high-quality surgical care. Building upon prior guidelines, quality indicators, and pilot projects, the Coalition for Quality in Geriatric Surgery (CQGS) includes 58 diverse stakeholder organizations committed to improving geriatric surgery.MethodsUsing a modified RAND-UCLA Appropriateness Methodology, 44 of 58 CQGS Stakeholders twice rated validity (primary outcome) and feasibility for 308 standards, ranging from goals and decision-making, pre-operative assessment and optimization, perioperative and postoperative care, to transitions of care beyond the acute care hospital.ResultsThree hundred six of 308 (99%) standards were rated as valid to improve quality of geriatric surgery. There were 4 sections. Section 1 included 157 (57%) standards and focused on goals and decision-making, preoperative optimization, and transitions into and out of the hospital. Section 2 included 84 (27.3%) standards focused on in-hospital care, across the immediate preoperative, intraoperative, and postoperative phases. Section 3 included 59 (19.1%) standards about program management, including personnel and committee structure, credentialing, and education. Section 4 included 8 (2.6%) standards establishing overarching concepts for data collection and patient follow-up. Two hundred ninety of 308 standards (94.2%) were rated as feasible; 18 (5.8%) were rated as uncertain in feasibility.ConclusionsCQGS Stakeholders rated the vast majority of standards of care as highly valid (99%) and feasible (94%) for improving the quality of surgical care provided to older adults. Future work will focus on a pilot phase to better understand and address challenges to implementation of the standards.

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