# Preparing older adults for major abdominal surgery: a systems engineering approach to implement preoperative comprehensive geriatric assessments

> **NIH NIH K23** · UNIVERSITY OF WISCONSIN-MADISON · 2024 · $190,383

## Abstract

PROJECT SUMMARY / ABSTRACT
Older Americans are a growing segment of the population with an increasing need for surgical services, and
they suffer a disproportionate burden of postoperative complications compared to their younger counterparts.
There are opportunities to reduce risk and improve surgical care delivery for this vulnerable population.
Preoperative comprehensive geriatric assessment (pCGA) optimizes multiple chronic conditions and factors
commonly overlooked in routine preoperative planning, including physical function, polypharmacy, nutrition,
cognition, mental health, and social/environmental support; pCGA has been shown to decrease postoperative
morbidity, mortality and length of stay in a variety of surgical specialties. Although national guidelines recommend
the use of pCGA, a paucity of strategic guidance for implementation limits its uptake to a few academic centers.
Systems-engineering and implementation science offer unique tools to reliably improve effective use of this
important intervention. The goal of this proposal is to use systems-based engineering methods to tailor and pilot
test a user-centered implementation package for the pCGA – one that can be adapted to community-based
hospitals in preparation for a multi-site implementation trial. This work will promote equitable access to the pCGA,
preserving effectiveness, protecting healthcare resources, and preventing avoidable morbidity and mortality.
This goal aligns with the National Institute on Aging’s strategic vision C3 to “Support the development of
behavioral interventions based on principles of basic behavioral and social science and designed with an eye to
real-world implementation, in line with the NIH Stage Model.”
My long-term goal is to improve surgical care for older adults through transdisciplinary research that promotes
implementation and dissemination of effective, evidence-based, patient-oriented interventions. This 5-year K23
proposal will provide me with mentored research experience and formal training in implementation science,
systems-engineering, clinical trials and aging research. With my strong background in surgical health services
research, I am well positioned to conduct this project and transition to research independence, with the support
of a team of expert mentors at an institution with an outstanding research environment.
The proposed research aims are to: 1) Map the pCGA process and identify system-based barriers and facilitators
to its use among older adults undergoing major abdominal surgery 2) Co-design an implementation package for
the pCGA applicable to a diverse population of older patients undergoing major abdominal surgery at (2a) a
large academic hospital and (2b) an affiliate community site, and 3) Test and refine the pCGA implementation
package in preparation for a future randomized controlled implementation-effectiveness trial. Upon completion
of this project, I will have an adaptable, user-centered implementation package for p...

## Key facts

- **NIH application ID:** 10827966
- **Project number:** 5K23AG081487-02
- **Recipient organization:** UNIVERSITY OF WISCONSIN-MADISON
- **Principal Investigator:** Julia Rose Berian
- **Activity code:** K23 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $190,383
- **Award type:** 5
- **Project period:** 2023-04-15 → 2028-03-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10827966

## Citation

> US National Institutes of Health, RePORTER application 10827966, Preparing older adults for major abdominal surgery: a systems engineering approach to implement preoperative comprehensive geriatric assessments (5K23AG081487-02). Retrieved via AI Analytics 2026-05-27 from https://api.ai-analytics.org/grant/nih/10827966. Licensed CC0.

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