HNS&CS Contributes to Improving Senior Surgical Care Through POSH Program

By Jessica Bronchick, Duke Surgery


The misconceptions surrounding health care and surgical care for senior patients are vast and nuanced, and ones that Duke’s Perioperative Optimization for Senior Health program (POSH) attempts to dispel. 

A Cross-Functional Approach to Senior Care

As a multidisciplinary, inter-departmental program, POSH brings together physicians and care providers to address issues specific to senior care and establish a path for a safe pre- and post-surgery experience. 

Russel Kahmke, MD, Assistant Professor of Head and Neck Surgery & Communication Sciences (HNS&CS), became involved with POSH in 2021 as the surgical director for the clinic. Dr. Kahmke’s role is to be “the voice of the surgeon” and help educate senior patients, and their families, on their surgical options, address their unique concerns, and to work with them to optimize the effects of their care.  

Some focuses, Dr. Kahmke says, are to, “decrease the length of the patient’s hospital stay, make sure they have limited complications such as delirium or infection, and to make sure that patients’ goals are being met.” 

Where HNS&CS Fits In

Many of these complications are often linked to issues like hearing loss, memory loss, and speech ability, which are core components of the HNS&CS department’s specialties. This, says Dr. Kahmke, is why it is so important for a program like POSH to have representation from the department in its leadership and administration.  

“It’s important because ENTs are trained to have an understanding about the different senses and how that plays a role in a patient’s experience and recovery,” says Dr. Kahmke. “It’s about understanding how things like hearing loss, swallowing, and overall functions of the head and neck contribute to surgical outcomes.” 

Dr. Kahmke

"ENTs are trained to have an understanding about the different senses and how that plays a role in a patient’s experience and recovery."

Russel Kahmke, MDAssistant Professor of HNS&CS

The POSH providers aim to look past age as a single determining factor in receiving care. The focus is to find ways to set patients up for success before, during, and after surgery. “That includes making sure that patients who might need hearing aids post-surgery have them; they have their glasses; they have appropriate ways to communicate and we have a support system available to them,” Dr. Kahmke says.

For patients who lack a home support network, POSH takes a more active role in setting expectations for post-surgery life. “We start that process early in their admission and having all of our allied professionals like nutritional support or dietitians, respiratory therapy, speech therapy, occupational therapy…making sure everyone is on the same page,” Dr. Kahmke explains. 

A Growing Program in a Growing Carolina

As Duke University Hospital looks to achieve Geriatric Surgery Verification (GSV) through the American College of Surgeons, the geriatric-centered POSH program is also evaluating how to meet the evolving demand in one of the fastest-growing areas in the state and country.  

“Having the GSV will allow us to continue to improve awareness of the POSH program among both surgeons and patients, and for POSH to be able to grow to meet the needs of the area,” says Dr. Kahmke.  

Though the program is led largely by geriatricians, the inter-departmental collaboration among members of POSH is essential to its own success, and that of its patients.