TPTh 4.16 Does Geriatric Involvement Protect Frail Patients Undergoing Emergency Laparotomy? An Exploratory Observational Study

This is the authors' abstract. We don't add key points for this paper.

Aims The National Emergency Laparotomy Audit (NELA) recommends a Peri-operative Care of Older People undergoing Surgery (POPS) review for patients undergoing emergency laparotomy aged ≥80 years (≥65 years if frail). We aimed to investigate patient characteristics, POPS review and outcomes between two acute hospitals within an NHS Trust, one with peri-operative geriatrics services and one without. Methods A retrospective observational study investigated patients aged ≥65 years undergoing emergency laparotomy over 6 months at a large NHS Trust. Age, Clinical Frailty Scale (CFS), co-morbidities, indication for surgery, length of stay (LOS), mortality and documentation of peri-operative decision-making were analysed. Results There were 90 patients with median age 78 (IQR 71–83) years (n=50 POPS site and n=40 non-POPS site). Bowel obstruction was the most common indication. POPS reviews were recorded for 64% (32/50) at the POPS site and 0/40 at the non-POPS site; p<0.001. Median LOS was higher at the POPS site (25 (IQR 12–40) vs. 11 (7–20) days; p<0.001), and a higher proportion required admission to the Intensive Care Unit (38/50 vs. 13/40 respectively; p<0.001). In-hospital mortality was 24% (12/50) vs. 30% (12/40) respectively; p=0.633). Documentation regarding operative decision-making was more complete at the POPS site, with earlier involvement of pre-operative optimisation. Conclusions There were comparable mortality outcomes between sites despite a more unwell POPS cohort, who were more often reviewed in the perioperative period by POPS. These data generate the hypothesis that peri-operative geriatrics involvement (as recommended by NELA) support safer emergency laparotomy care.