Impact of an Integrated Older Persons Assessment and Liaison (iOPAL) Service on Geriatric Assessment and 30-Day Mortality Following Emergency Laparotomy

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Introduction Older patients undergoing emergency laparotomy have high rates of postoperative complications and mortality, particularly those who are frail. Historically, geriatric involvement in perioperative care has been inconsistent. The Integrated Older Persons Assessment and Liaison (iOPAL) service was introduced to improve multidisciplinary assessment and management of frail surgical patients. This study evaluated its impact on 30-day in-hospital mortality and rates of geriatric assessment in eligible patients at a local hospital in Surrey. Methods A retrospective analysis of National Emergency Laparotomy Audit (NELA) cases was undertaken. Mortality trends were assessed using Exponentially Weighted Moving Average (EWMA) charts comparing observed versus predicted 30-day in-hospital mortality, focusing on March-May 2021 and September 2021-February 2022. Rates of geriatric assessment were calculated across four consecutive audit periods for patients aged ≥65 and frail or ≥80. Results From 1 March-31 May 2021, 45 NELA patients were treated; 6.7% received geriatric review. From 1 September-30 November 2021, 35 patients were treated, with geriatric assessment rising to 46.7%. From 1 October-31 December 2021, 34 patients were treated, with 75% assessed by geriatrics. From 1 January-31 March 2022, 33 patients were treated, with 93% receiving geriatric input. WMA charts demonstrated a sustained reduction in observed compared with predicted 30-day in-hospital mortality following iOPAL implementation. Conclusion Implementation of the iOPAL service was associated with substantially improved geriatric engagement and a sustained reduction in 30-day in-hospital mortality after emergency laparotomy, supporting integrated perioperative care for frail older adults. Further evaluation in larger cohorts is warranted.