TPW 4.08 Scaling Up Comprehensive Geriatric Assessment for Older People Undergoing Cholecystectomy

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

Background Approximately 66% of elective and 40% of emergency surgical procedures occur in patients aged over 65-years-old. The POPS-SUp (Perioperative Medicine for Older People Undergoing Surgery Scale-Up) study aims to understand whether comprehensive geriatric assessment-based services can improve clinical outcomes for these patients. This audit analyses the burden of cholecystectomy in over 65's to inform the use case in developing our POPS service. Methods A retrospective audit of all cholecystectomies (September 2024-September 2025) in patients aged ≥65 at an EGS unit was undertaken. Cholecystectomies were categorised into emergency or elective. Outcomes were compared with national NHS England Model Hospital cholecystectomy data for all ages. Results 670 cholecystectomies were identified; 95/475 (20%) elective and 51/195 (26%) emergency were in patients aged ≥65. Median age 72 years (IQR 67-76) in elective and 74 years (IQR 71-78) in emergency cholecystectomy. Frailty assessment was undertaken in 7.5% (11/146) and perioperative geriatrician review occurred in 2.7% (4/146). The minimal access rate for elective cholecystectomy was 88.9% (national median 98.3%) and 78.4% for emergency cholecystectomy (national median 95.4%). In the elective cohort, 48.8% were day case procedures and the readmission rate was 11.0% (national median 71.4% and 8.8%). Complications (Clavien-Dindo III or greater) occurred in 4.2% of elective cholecystectomy and 17.6% of emergency cholecystectomy. 90-day mortality for emergency cholecystectomy was 6%. Conclusion More than 20% of patients undergoing cholecystectomy are ≥65. Older patients have higher conversion rates, readmissions, and post-operative complications. Identifying frailty pre/perioperatively may improve uptake and impact of comprehensive geriatric assessment-based services.