Frailty in Emergency Laparotomy and Laparoscopic Scottish Audit (ELLSA) Patients

Abstract

Abstract Aims Early identification of frailty is essential in the older emergency surgical patient. The latest NELA report highlights the importance of care of the elderly reviews in reducing mortality in this patient population. In our organisation, the geriatrician led Surgical Acute Frailty Team (SAFT) reviews patients aged ≥ 65 years included in the Emergency Laparotomy and Laparoscopic Scottish Audit (ELLSA). Our aim was to establish frailty identification in ELLSA patients and to review outcomes on discharge. Methods A subset of data collected as part of our organisation’s ELLSA was reviewed. Data included documentation of Clinical Frailty Scale Score (CFS), review pre-operatively and during admission by SAFT and discharge destinations. Results 146 patients aged ≥ 65 years underwent emergency surgery as defined by ELLSA criteria from July 2022 to August 2023. 98.6% of patients had a documented CFS score (mean 3.6). 87.7% of patients were reviewed by SAFT; 63.3% of patients had a pre-operative frailty review. 70% of patients were discharged home independently with 7% requiring a care package on discharge. Conclusions In our organisation, frailty assessment in emergency laparotomy patients is significantly above the 31.8% documented in the 8th NELA report. The majority of patients are discharged home without additional support. Shared decision making is vital in this patient cohort. We have established frailty screening on admission, introduced a weekly MDT for ELLSA patients and installed a designated ELLSA patient MDT board with the aim of ensuring 100% of ELLSA patients aged ≥ 65 years have a geriatrician review.