SRS246 - Addressing the double burden: elevated mortality and missed tariff opportunities in octogenarians undergoing emergency laparotomy—a case for geriatric surgical liaison services in NHS hospitals

Emergency laparotomies in octogenarians represent a growing national challenge, combining high clinical risk with substantial financial loss to NHS hospitals. A three-year retrospective review at George Eliot Hospital analysed 370 emergency laparotomies, including 62 patients aged ≥80 years. The mean age was 84 years; 56.5% underwent bowel resection and 16.1% required stoma formation. The 30-day mortality rate was 21%, considerably exceeding national benchmarks. None of these patients received perioperative geriatric input. A concurrent audit assessing compliance with the 2023 National Emergency Laparotomy Audit (NELA) Best Practice Tariff (BPT) showed 0% compliance for elderly care review in patients ≥80 years, translating to an estimated annual revenue loss of £119 978–£152 008. This double burden of excess mortality and missed BPT income highlights a systemic gap in emergency surgical pathways. Evidence from NELA demonstrates that integrating geriatricians into perioperative care improves survival, optimises recovery, and enhances discharge planning. We propose a Geriatric Surgical Liaison Service embedded within all NHS emergency surgical units, featuring twice-weekly consultant geriatrician ward rounds, frailty scoring at admission, and joint surgical-geriatric care planning. Implementing this model across NHS hospitals would address both patient safety and financial sustainability, aligning clinical excellence with economic responsibility. The findings present a compelling case for national adoption of geriatric surgical liaison services—transforming outcomes for frail elderly patients while supporting Trusts to achieve Best Practice Tariff compliance and reinvest savings into frontline care.