Abstract

Background Surgery provides definitive management of many age-related diseases, relieving symptoms or extending life. Age-related physiological decline, multimorbidity and frailty predispose older people to postoperative complications, incomplete functional recovery with resultant health and social-care cost. These age-related conditions can be optimised using Comprehensive Geriatric Assessment (CGA) thus mitigating perioperative risk to improve clinical outcomes with cost-effectiveness. National organisations advocate CGAbased services for older surgical patients. However, variation exists in the provision of CGA-based Perioperative medicine for Older People undergoing Surgery (POPS) services across the United Kingdom (UK) National Health Service (NHS) resulting in inequitable access for higher-risk, older surgical patients, unnecessary deaths, complications and financial cost. The aim of this study is to evaluate whether CGA-based POPS services can be implemented at scale, to improve clinical outcomes for older patients undergoing surgery with cost-effectiveness. Methods A mixed-methods hybrid implementation-effectiveness, interrupted time-series study will examine the use of a coproduced implementation strategy to embed CGA-based POPS services at scale in the UK. Co-primary implementation-effectiveness outcomes will be used; reach and length-of-hospital-stay respectively. Evaluation will include an embedded process evaluation, quantitative evaluation of clinical and cost effectiveness and qualitative appraisal of patient and staff experience. The proposed analysis is to embed a process evaluation utilising real time framework analysis enabling iterative refinement and evaluation of the implementation strategy. Accepted interrupted time series analysis will be used to examine and compare outcomes per participating site. A predefined dissemination strategy has been co-designed with patients/carers, clinical community of practice and organisational bodies. Conclusion The anticipation is that POPS-SUp will have impact at individual (patient and clinician), organisational and policy level in the perioperative setting but additionally with potential application to other clinical settings.