Abstract
IntroductionAlthough high rates of in-hospital mortality have been described in older patients undergoing emergency laparotomy (EL), less is known about longer-term outcomes in this population. We describe factors present at the time of hospital admission that influence 12-month survival in older patients.MethodsObservational study of patients aged 75 years and over, who underwent EL at our hospital between 8th September 2014 and 30th March 2017.Results113 patients were included. Average age was 81.9 ± 4.7 years, female predominance (60/113), 3 (2.6%) lived in a care home, 103 (91.2%) and 79 (69.1%) were independent of personal and instrumental activities of daily living (ADLs) and 8 (7.1%) had cognitive impairment. Median length of stay was 16 days ± 29.9 (0–269); in-hospital mortality 22.1% (25/113), post-operative 30-day, 90-day and 12-month mortality rates 19.5% (22), 24.8% (28) and 38.9% (44). 30-day and 12-month readmission rates 5.7% (5/88) and 40.9% (36). 12-month readmission was higher in frail patients, using the Clinical Frailty Scale (CFS) score (64% 5–8 vs 31.7% 1–4, p = 0.006). Dependency for personal ADLs (6/10 (60%) dependent vs. 38/103 (36.8%) independent, p = 0.119) and cognitive impairment (5/8 (62.5%) impaired vs. 39/105 (37.1%) no impairment, p = 0.116) showed a trend towards higher 12-month mortality. On multivariate analysis, 12-month mortality was strongly associated with CFS 5–9 (HR 5.0403 (95% CI 1.719–16.982) and ASA classes III–V (HR 2.704 95% CI 1.032–7.081).ConclusionFrailty and high ASA class predict increased mortality at 12 months after emergency laparotomy. We advocate early engagement of multi-professional teams experienced in perioperative care of older patients.
Highlights
High rates of in-hospital mortality have been described in older patients undergoing emergency laparotomy (EL), less is known about longer-term outcomes in this population
The mean age was 81.9 ± 4.65 years; there was a female predominance at 53.1% and 49 (43.3%) were American Society of Anaesthetists (ASA) class I or II
2.7% of the cohort was admitted from a care home. 97 (83.2%) mobilised independently with a stick or no aid, and cognitive impairment was present in 8 (7.10%). 104 patients (92%) and 109 patients (96.4%), respectively, were continent of urine and faeces
Summary
High rates of in-hospital mortality have been described in older patients undergoing emergency laparotomy (EL), less is known about longer-term outcomes in this population. Conclusion Frailty and high ASA class predict increased mortality at 12 months after emergency laparotomy. Increasing age is associated with multimorbidity, reduced physiological ability to accommodate the stress of surgery and higher rates of mortality and morbidity [3,4,5,6]. Surgical collaboration with medical care of the older person (MCOP) teams is an audit standard for the National Emergency Laparotomy Audit (NELA) 2. To date, this need has remained considerably unmet with input only provided in 19% of cases 2
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