What is POSH?

If you are an older adult preparing to have surgery at Duke, your surgeon may recommend that you participate in the Duke POSH program. POSH stands for Perioperative Optimization of Senior Health.

The goal of POSH is to set the stage for a safe surgical experience and a smooth recovery for older patients.


Older adults are more at risk for certain problems (complications) during and after surgery. Why? Because older adults are more likely to have

  • multiple chronic conditions that may place extra stress on their bodies during and after surgery
  • problems with mobility, physical fitness, hearing, or vision that make it harder to undergo surgery and recover quickly
  • issues related to cognition, mood, and social circumstances
  • prescriptions for many medications, some of which may increase the risk for certain complications after surgery

With POSH, these issues are addressed ahead of time with the goal of avoiding problems later.

How does POSH work?

Several weeks before surgery, you will meet with different members of the POSH team. The POSH team works together to assess you and your health to find out what issues might make it harder to undergo surgery and recover afterwards. The team may adjust medications, suggest exercise or physical therapy, or refer you to a specialist to improve the control of chronic condition like diabetes. The team also works closely with your surgeon and the anesthesia department, sharing information about medical or social issues that may need particular attention during and after surgery.

Does POSH really help?

Yes! The POSH model of care helps older surgical patients recover quicker and with fewer complications. Read about a study of the program in JAMA Surgery.

In fact, a study at Duke showed that patients participating in POSH were able to leave the hospital on average nearly two days earlier and were much less likely to have to be readmitted to the hospital compared to those not in the POSH program.

  Average Length of Stay in Hospital Percent of Patients Readmitted Within 7 Days of Leaving Hospital
Patients with POSH 4 days 2.8%
Patients without POSH 6 days 9.9%

This table shows the results of a study with 326 adults aged 65 and older who had elective abdominal surgery at Duke between January 2010 and June 2015. [Source: Integrated Care Coordination Improves Postsurgical Outcomes in High Risk Older Adults: The Perioperative Optimization of Senior Health (POSH) Initiative by McDonald et al.]