‘Am I ever going to get back to being how I was before?’: the experience of emergency laparotomy for older people living with frailty

Abstract Introduction Older people living with frailty are at high risk of adverse clinical outcomes following emergency laparotomy, including functional deterioration, hospital readmission, and death. Despite this, there is a paucity of literature exploring patient experience in this group, and little is known about what factors influence recovery. As a result, there is limited information to guide the development of robust post-operative care pathways that support optimal recovery and improve the overall experience. Methods Twenty older people, aged ≥ 65 years, with a Clinical Frailty Scale score of ≥ 4 and who had undergone emergency laparotomy were recruited from eight hospital sites over an eight-month period. Semi-structured interviews were undertaken approximately one month after surgery to explore the peri-operative and early recovery experience. Data were analysed using reflexive thematic analysis. Results Participants described their experience of undergoing emergency laparotomy over five temporal themes, starting at the experience around the time of surgery, followed by the early recovery period and ending with reflections of the overall experience: feeling out of control in the acute phase , memory and understanding of the surgery , physical and psychological implications , transitional care needs , reflecting on recovery . Conclusion Undergoing emergency laparotomy appears to be a significant and potentially life-changing event for older people living with frailty, but one that they expressed gratitude to have experienced to remain alive. Our findings highlight the challenges encountered by this group across the perioperative and early recovery period, indicating that adaptations to service delivery may improve this experience and facilitate recovery.