Enhancing geriatric care through co-management: a narrative review of collaborative medical-surgical models

Co-management models for older surgical patients evolved from the hospitalist movement and early orthogeriatric programs. Unlike reactive consultation, the co-management model, in which hospitalists or geriatricians share responsibility with surgeons for patient care throughout the hospital stay, may improve perioperative outcomes and patient experience. Despite heterogeneity in co-management models and limited high-quality evidence, it thus offers a promising framework for geriatric surgical care implementation. Unlike traditional consultation models, co-management ensures early and continuous medical oversight, optimizes perioperative management, including appropriate medication use, reduces complications, and enhances safe discharge planning. Several studies have demonstrated that co-management with various surgical teams, such as trauma surgery, vascular surgery, orthopedics, and neurosurgery, reduces mortality rates, improves satisfaction among both patients and healthcare providers, is cost-effective, and possibly shortens hospital stays. Nevertheless, challenges with co-management remain, including care fragmentation, communication issues, and increased workload for hospitalists or geriatricians. Successful implementation depends on institutional support, clearly defined roles, and appropriate patient selection. Given the growing complexity of hospitalized older adults, the co-management model represents a critical evolution in multidisciplinary surgical care, but further research is needed to establish best practices.