Older age (≥65 years) in patients undergoing emergency laparotomy was associated with significantly higher 30-day mortality compared to younger patients (15.3% vs 4.9%; P<0.001).
Observational (n=93,415)
Yes
Does post-operative geriatrician review reduce mortality in older patients undergoing emergency laparotomy?
Older patients undergoing emergency laparotomy have higher mortality and longer length of stay, but post-operative geriatrician review is associated with significantly reduced 30- and 90-day mortality.
Absolute Event Rate: 15.3% vs 4.9%
p-value: p=<0.001
BACKGROUND: older patients aged ≥65 years constitute the majority of the National Emergency Laparotomy Audit (NELA) population. To better understand this group and inform future service changes, this paper aims to describe patient characteristics, outcomes and process measures across age cohorts and temporally in the 4-year period (2014-2017) since NELA was established. METHODS: patient-level data were populated from the NELA data set years 1-4 and linked with Office of National Statistics mortality data. Descriptive data were compared between groups delineated by age, NELA year and geriatrician review. Primary outcomes were 30- and 90-day mortality, length of stay (LOS) and discharge to care-home accommodation. RESULTS: in total, 93,415 NELA patients were included in the analysis. The median age was 67 years. Patients aged ≥65 years had higher 30-day (15.3 versus 4.9%, P < 0.001) and 90-day mortality (20.4 versus 7.2%, P < 0.001) rates, longer LOS (median 15.2 versus 11.3 days, P < 0.001) and greater likelihood of discharge to care-home accommodation compared with younger patients (6.7 versus 1.9%, P < 0.001). Mortality rate reduction over time was greater in older compared with younger patients. The proportion of older NELA patients seen by a geriatrician post-operatively increased over years 1-4 (8.5 to 16.5%, P < 0.001). Post-operative geriatrician review was associated with reduced mortality (30-day odds ratio OR 0.38, confidence interval CI 0.35-0.42, P < 0.001; 90-day OR 0.6, CI 0.56-0.65, P < 0.001). CONCLUSIONS: older NELA patients have poorer post-operative outcomes. The greatest reduction in mortality rates over time were observed in the oldest cohorts. This may be due to several interventions including increased perioperative geriatrician input.
Aitken et al. (Thu,) conducted a observational in Emergency laparotomy (n=93,415). Age ≥65 years vs. Age <65 years was evaluated on 30-day mortality (p=<0.001). Older age (≥65 years) in patients undergoing emergency laparotomy was associated with significantly higher 30-day mortality compared to younger patients (15.3% vs 4.9%; P<0.001).