Implementation and Outcomes of a Perioperative Geriatrics Strategy, PRIME, for Older Adults Undergoing Gastrointestinal Cancer Surgery

Sep 23, 2026

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Older adults facing frailty increasingly undergo gastrointestinal cancer surgery, creating demand for tailored perioperative geriatric care. This study evaluates PRIME, a whole-pathway perioperative geriatrics strategy that integrates comprehensive geriatric assessment (CGA), collaborative care among surgery, geriatrics, and anesthesia, and postoperative co-management. Using validated structural, process, and outcome quality indicators, a retrospective cohort of 106 patients aged 70+ (2020–2023) showed high adherence to CGA and geriatric screening, with favorable structural/process performance.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages13

Reading Time33 min

AccessFree to download

Introduction

Study objectives and design

Materials and Methods

Quality indicators and cohort

Results

Structural and process adherence

Outcomes and complications

Conclusions

Article Implementation and Outcomes of a Perioperative Geriatrics Strategy, PRIME, for Older Adults Undergoing Gastrointestinal Cancer Surgery Gabriella Jacob 1, Eric K. C. Wong 1,2,3, Rachel Fuh 4, Tyler R. Chesney 2,5 and Camilla L. Wong 1,2,3, * Received: 28 July 2025 Revised: 27 August 2025 Accepted: 2 September 2025 Published: 3 September 2025 Citation: Jacob, G.; Wong, E.K.C.; Fuh, R.; Chesney, T.R.; Wong, C.L. Implementation and Outcomes of a Perioperative Geriatrics Strategy, PRIME, for Older Adults Undergoing Gastrointestinal Cancer Surgery. Curr. Oncol. 2025, 32, 494. [https://](https://)[ ](https://)[doi.org/10.3390/curroncol32090494](doi.org/10.3390/curroncol32090494) [Copyright:](Copyright:) © 2025 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ([https://creativecommons.org/](https://creativecommons.org/)[ ](https://creativecommons.org/)[licenses/by/4.0/](licenses/by/4.0/)) . 1 Division of Geriatric Medicine, Department of Medicine, University of Toronto, 6 Queen’s Park Crescent West, Toronto, ON M5S 3H2, Canada; [gabi.jacob@mail.utoronto.ca](gabi.jacob@mail.utoronto.ca) (G.J.) 2 Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria St, Toronto, ON M5B 1X3, Canada; [tyler.chesney@unityhealth.to](tyler.chesney@unityhealth.to) 3 Division of Geriatric Medicine, St. Michael’s Hospital, 30 Bond Street, Toronto, ON M5B 1W8, Canada 4 Faculty of Arts and Science, Queen’s University, 99 University Avenue, Kingston, ON K7L 3N6, Canada; [21ref8@queensu.ca](21ref8@queensu.ca) 5 Division of General Surgery, Department of Surgery, University of Toronto, 149 College Street, Toronto, ON M5T 1P5, Canada * Correspondence: [camilla.wong@unityhealth.to](camilla.wong@unityhealth.to) Simple Summary Older adults undergoing gastrointestinal surgery for cancer or pre-cancerous lesions received a whole pathway perioperative geriatrics strategy which included preoperative comprehensive geriatric assessment, collaborative care between surgery, geriatrics, and anesthesia, and post-operative co-management. There was good adherence to validated structural and process quality indicators. Outcome quality indicators demonstrated that this strategy compares favorably with other studies. Abstract Introduction: The number of older adults living with frailty undergoing gastrointestinal cancer surgery is increasing. To address the unique needs of the population, a whole pathway perioperative geriatrics strategy—PRIME—was developed to integrate geriatric principles into surgical care. The objective of this study was to evaluate the implementation of PRIME using validated structural, process, and outcome quality indicators. Materials and Methods: This retrospective cohort study included 106 consecutive patients aged 70 years and older who underwent gastrointestinal surgery for cancer or pre-cancerous lesions at a single institution between 1 July 2020 and 5 October 2023 . The whole pathway perioperative geriatrics strategy, PRIME, includes preoperative comprehensive geriatric assessment (CGA), collaborative care between surgery, geriatrics, and anesthesia, and post-operative co-management. Implementation was evaluated using validated structural, process, and outcome quality indicators. Results: Most structural indicators (five of eight) were implemented. In terms of process indicators, 96.2%(n = 102) received CGA prior to or within 24 h of admission. Adherence to screening was high: 97.2% for dementia, 96.2% for functional status, and 95.3% for frailty. The median number interventions resulting from CGA was 17 (IQR 14–20) . Serious complication, delirium, and functional decline occurred in 19.8%, 27.1%, and 19.8%, respectively. Conclusions: Implementation of a perioperative geriatrics strategy for older adults undergoing gastrointestinal cancer/pre-cancer lesion surge

FAQs

What is PRIME in the context of perioperative geriatrics?

PRIME is a whole-pathway perioperative geriatrics strategy that integrates preoperative comprehensive geriatric assessment, collaborative care between surgery, geriatrics, and anesthesia, and postoperative co-management.

How was implementation of PRIME evaluated?

Implementation was assessed using validated structural, process, and outcome quality indicators in a retrospective cohort of 106 consecutive patients aged 70 and older.

What were the main findings regarding adherence and outcomes?

Most structural indicators were implemented, CGA was delivered before or within 24 hours of admission for most patients, and screening adherence for dementia, functional status, and frailty was high. Serious complications, delirium, and functional decline occurred at reported rates.

Sep 23, 2026

Uploaded by Ben