QS123 - Perspectives of Aging Patients Facing Elective Surgery for Diverticulitis: A Qualitative Study

Sunday, June 2, 2024

11:27 AM – 11:30 AM ET, USA

Location: Room 327

Quick Shot Presenter(s)

Atziri Rubio-Chavez, MD (she/her/hers)

Research Fellow
Massachusetts General Hospital
Massachusetts General Hospital
Boston, MA, United States

All relevant financial disclosures have been managed and will be listed below.
This individual has no financial relationships with ineligible companies.

Author(s)

Stefanie J. Soelling, MD, MPH

Resident
Brigham and Women's Hospital
Boston, MA, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.
LB

Laura Baird, n/a

Research Assistant
Ariadne Labs, Harvard
provo, Utah, United States

Disclosure information not submitted.
BT

Bridget Towle, RN

Registered Nurse
MGH
Bedford, Massachusetts, United States

Disclosure information not submitted.
HK

Hiroko Kunitake, MD MPH

Assistant Professor
Harvard Medical School
Boston, Massachusetts, United States

Disclosure information not submitted.
Liliana Bordeianou, MD

Professor of Surgery
Harvard Medical School / Massachusetts General Hospital
Harvard
Boston

All relevant financial disclosures have been managed and will be listed below.
This individual has no relevant relationships with ineligible companies.
Rocco Ricciardi, MD, MPH

Chief, Section of Colon & Rectal Surgery
Massachusetts General Hospital
Boston, Massachusetts, United States

Disclosure information not submitted.
AV

Ana-Maria Vranceanu, PhD

Assoc Prof
HMS
Boston, Massachusetts, United States

Disclosure information not submitted.
ZC

Zara Cooper, MD, MSc

Professor of Surgery
Brigham and Women's Hospital
Roxbury Crossing, Massachusetts, United States

Disclosure information not submitted.
CR

Christine Ritchie, MD, MSPH

Professor of Medicine
Massachusetts General Hospital and Harvard Medical School
Charlestown, Massachusetts, United States

Disclosure information not submitted.

Senior Author(s)

Christy Cauley, MD, MPH (she/her/hers)

Assistant Professor
MGH
Massachusetts General Hospital; Harvard Medical School
Boston, MA, United States

All relevant financial disclosures have been managed and will be listed below.
This individual has no relevant relationships with ineligible companies.

Purpose/Background: Diverticulitis is a common cause of colorectal resection among adults aged 65 and above, a rapidly growing part of the U.S. population. Identifying unique challenges older adults face is a necessary step to address perioperative geriatric vulnerabilities.

Objective: 1) Describe challenges older adults undergoing elective surgery for diverticulitis face perioperatively, and 2) how challenges vary across the aging spectrum.

Methods/Interventions: Patients 30-90 days after elective colectomy for diverticulitis were recruited from a single outpatient surgical clinic. We performed semi-structured 1:1 interviews guided by the geriatric 5 M's framework (i.e., Mind, Mobility, Medications, What Matters Most, and Multicomplexity). A hybrid deductive-inductive coding approach was used; thematic analysis was performed.

Results/Outcomes: Twenty older adults (65-83 years, median 70 years, 80% female) who underwent elective diverticulitis surgery (i.e., indications: recurrent, smoldering, fistula formation) were interviewed.
Preoperatively, the majority of patients felt confident about their physical function and health status. Patients who self-identified as having multimorbidity were concerned about self-care capacity after surgery. Patients felt anxious/nervous about surgery and potential: complications, decrease in cognition, or dependence. Medication and bowel preparation information inconsistencies raised challenges.
Postoperatively, patients reported challenges related to pain control, fatigue, and difficulty completing activities of daily living (i.e., using the toilet or showering). Some expressed a need for support from a care partner (e.g., family or friends) or a visiting nurse. Those who lived alone described major challenges related to receiving social support. The majority of patients noted that their emotional status improved after surgery. Polypharmacy was noted to cause medication difficulties (i.e., unclear timing/dosing) for a few patients. Diet instructions were frequently perceived as insufficient. Follow-up of residual symptoms and support during care transitions back to their primary care was lacking.
Perioperatively, several patients noted difficulty with food intake due to pain, nausea, and decreased appetite. Patients with multimorbidity noted that they felt weak or frail prior to surgery and decreased ability to recall instructions after surgery. Some patients noted difficulties communicating with care partners or staff, delays when using remote communication (i.e., virtual visits or patient portals), and care delays due to living long distances from the hospital.
A mixed methods analysis showed differences in challenges by age group (65-69, 70-74, 75-79, and 80+). When asked about their experience on the day of surgery, patients of all groups feared death during surgery, citing older age as a factor. When asked about “what matters most” after surgery, the youngest patients (65-74) prioritized resuming caregiving, work, physical exercise, or travel. In contrast, the older patients (75+) valued returning to previous activities of daily living, feeling independent, feeling healthy, and caring for pets.

Conclusion/Discussion: Challenges faced by older adults recovering from elective colectomy for diverticulitis vary by age, comorbidities, and social support. Health systems and surgeons need to focus on these concerns in order to better serve our growing elderly surgical population.