Abstract
Increasing numbers of older patients require Emergency admission under General Surgery (EGS). This is a group of heterogeneous and often complex individuals with varying degrees of multimorbidity, polypharmacy, functional, mobility and cognitive impairment. Our article describes the benefits of comprehensive assessment coupled with patient-centred multiprofessional interventions and timely discharge planning. We discuss diverse service models and describe our experience in the planning, development and consolidation of a perioperative service for older EGS patients.
Highlights
The unstoppable demographic shift, coupled with drastic decreases in elective surgical interventions after the age of 75 years [2], has resulted in higher numbers of older people being admitted as surgical emergencies [3]
The most prevalent conditions are hepatopancreaticobiliary and colorectal disorders which together amount to 43% of all Emergency general surgery (EGS) diagnoses
We have developed a general surgical in-reach service in the last 3 years, and in this time have had input into more than 1300 older people
Summary
Optimisation of medical problems and pre-operative involvement of a consultant anaesthetist when a surgical intervention is likely to benefit the patient has been shown to improve clinical outcomes. Those patients undergoing major operations and those whose operative mortality risk exceeds 5% should be transferred from theatre into a high dependency area post-surgery. In our experience, impaired cognition and functional status, and the presence of incontinence reliably predict in-hospital mortality These are domains that are rarely considered by surgical teams at patient presentation but are routinely assessed as part of CGA. The cost-effectiveness of such services would need to be determined for sustainability
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