Perioperative Care for Older Patients Undergoing Emergency Surgery: A Single Centre Audit

Introduction Perioperative care for older patients undergoing emergency surgery is poorer than that received by younger age groups; morbidity and mortality exceed that predicted by their pre-existing co-health. The Royal College of Anaesthetists sets standards to improve their care. Methods Retrospective data collection over three months was carried out using electronic patient records at a district general hospital, with a sample size of 50 patients. Patients aged 75 and over that had undergone emergency surgery in trauma theatres or emergency theatres were included. Data collection was split into perioperative measures and intraoperative measures. Results Perioperative measures: Among patients undergoing surgery for trauma, 93% had a pre-operative delirium screen and 77% had a post-operative delirium screen. Emergency theatre patients had a much lower rate of screening: 15% and 0%, respectively. 93% of trauma patients had geriatrician input compared to 15% in emergency theatres. Intraoperative measures: 25% of operative time was spent with systolic blood pressure (BP) <100mmHg in emergency theatres, compared to 12% in trauma theatres. 21% of operative time was spent with minimum alveolar concentration (MAC) >1 in emergency theatres, of which 10% had processed electroencephalogram monitoring (pEEG). In trauma theatres, 41% of time was spent with MAC >1, of which 62% had pEEG. Conclusions Established pathways and standards of care for older patients undergoing surgery in trauma theatres likely result in improvement in perioperative and intraoperative measures. We propose a bundle of care for patients undergoing surgery in emergency theatres consisting of improved access to geriatrician input, altered anaesthetic charts to include prompts for BP targets and use of pEEG, and a modified WHO checklist.