1001 IMPACT OF THE INTRODUCTION OF ROUTINE GERIATRICIAN REVIEW FOR OLDER ADULTS UNDERGOING EMERGENCY LAPAROTOMY

Abstract

Abstract Introduction The number of older adults having emergency abdominal surgery is increasing nationally. In the last National Emergency Laparotomy Audit (NELA) report, 55% of patients were over 65 and 18% were over 80. The wide disparity in mortality rate between under- and over-65 s has persisted since data began collection in 2013. (NELA Seventh Report, 2021). There is already good evidence in Orthopaedic and Vascular surgery that Geriatrician input can improve outcomes including mortality and length of stay. We introduced a Consultant-led service to review every NELA patient aged 65 and above and review the effect on post-operative outcomes. Method We clinically reviewed NELA qualifying patients aged ≥65 years between September 2020–September 2021. Data including Rockwood Clinical Frailty Score (CFS), NELA mortality risk prediction score, 30-day mortality and discharge destination were analysed. Results In total we reviewed 88 patients in 1 year. The median age was 77.5 (range 64–96) years. The median CFS was 3 (range 1–7). 23% patients had a CFS ≥5. 65% patients had a NELA score > 5% (high risk) including 30% with a NELA Score > 20%. The average NELA score was 13.8%. The overall 30-day mortality rate for our cohort was 5.8%; comprised of 10% and 4.7% for patients with a CFS ≥5 and CFS <5 respectively. On discharge, 92% of patients returned to their own home. Conclusion We have demonstrated routine review of NELA patients ≥65 years by a Geriatrician-led service has drastically improved outcomes. The mortality rate for both 1) Overall ≥65 (5.8%) and 2) CFS ≥5 (10%) are significantly lower than the national average of 14.6% (ELF Study, 2021) and 18.6% respectively. Importantly, most of these patients were also able to return to their own home. Further research needs to be done on assessing whether reviewing patients pre-operatively can further improve outcomes.