Preliminary data demonstrate the Geriatric Surgery Verification program reduces postoperative length of stay.

OBJECTIVES/BACKGROUND: The Geriatric Surgery Verification (GSV) Program promotes clinical standards aimed to optimize the quality of surgical care delivered to older adults. The purpose of this study was to determine if preliminary implementation of the GSV Program standards improves surgical outcomes. DESIGN: Prospective study with cohort matching. SETTING: Data from a single institution compared with a national data set cohort. PARTICIPANTS: All patients aged ≥75 years undergoing inpatient operations between January 2018 and December 2019 were included. Cohort matching by age and procedure code was performed using a national data set. MEASUREMENTS: Baseline pre- and intraoperative characteristics prospectively recorded using Veterans Affairs Surgical Quality Improvement Program (VASQIP) variable definitions. Postoperative outcomes were recorded including complications as defined by VASQIP, 30-day mortality, and length of stay. RESULTS: A total of 162 patients participated in the GSV program, and 308 patients comprised the matched comparison group. There was no difference in postoperative occurrence of one or more complications (p = 0.81) or 30-day mortality (p = 0.61). Patients cared for by the GSV Program had a reduced postoperative length of stay (median 4 days [range 1,31] vs. 5 days [range 1,86]; p < 0.01; and mean 5.4 ± 4.8 vs. 8.8 ± 11.8 days; p < 0.01) compared with the matched cohort. In a multivariable regression model, the GSV Program's reduced length of stay was independent of other associated covariates including age, operative time, and comorbidities (p < 0.01). CONCLUSION: Preliminary implementation of the GSV Program standards reduces length of stay in older adults undergoing inpatient operations. This finding demonstrates both the clinical and financial value of the GSV Program.

Comparing pure-, pulsed, and warbled tone thresholds in adults at 3000 and 6000 Hz.

PURPOSE: Pulsed and warbled tones are suitable substitutions for pure tones in hearing threshold measurement according to the 2005 American Speech-Language-Hearing Association guidelines. These guidelines also recommend measuring thresholds at 3000 and 6000 Hz. To date, there is no research directly supporting substitution of pulsed or warbled tones for pure tones at 3000 and 6000 Hz for listeners with normal hearing or with hearing loss. This study compared pure-, pulsed, and warbled tone thresholds at 3000 and 6000 Hz. METHOD: Forty-seven adults with normal hearing and 16 adults with sensorineural hearing loss participated in this study. Air-conduction thresholds were elicited with pure tones at octave intervals from 250 to 8000 Hz and with pure-, pulsed, and warbled tone stimuli at 3000 and 6000 Hz. RESULTS: Small mean differences in thresholds were obtained using each of the 3 stimulus types for both listeners with normal hearing and hearing loss. Some of the mean differences tested were found to be statistically significant. The differences were nevertheless small and in all cases within the clinically accepted 5-dB step size. CONCLUSION: Although substitutions did not violate the 5-dB step size, the slope of a listener's hearing loss may be a factor in the inaccuracy of measurement during the substitution of warbled tones for pure tones.