“I didn’t personally think it would change my life, but it has”: The experience following emergency laparotomy for older people living with frailty

Abstract

Abstract Introduction Older people living with frailty are at high risk of adverse clinical outcomes following emergency laparotomy, including early death, hospital readmission and functional decline. Despite this, there is a paucity of literature exploring patient experience of surgery in this group, particularly following hospital discharge. There is therefore limited information to guide the development of service delivery models that support optimal post-operative recovery and improve overall experience. Methods Twenty older people, aged ≥65 years, with a Clinical Frailty Scale score of ≥ 4 and who had undergone emergency laparotomy were recruited from eight hospital sites. Participants were interviewed 3 weeks following their surgery, or the earliest convenient date. Interviews were undertaken either face to face or via telephone and explored the peri-operative and early recovery experience. Data were analysed using reflexive thematic analysis. Results Participants described physical, psychological, and social implications following emergency laparotomy which extended further than hospital discharge. Recovery was perceived to be an ongoing and slow process of returning to ‘normal self’. Although generally satisfied with in-hospital care, a lack of access to discharge advice and community follow up left some participants feeling ‘abandoned’ and uncertain once they returned home, hindering recovery. Conclusions Older people living with frailty experience multifaceted consequences of emergency laparotomy that result in a prolonged recovery phase and care needs. Multi-disciplinary post-operative pathways are imperative in addressing these holistic care needs. Better access to information and enhanced community support could improve patient experience and facilitate ongoing recovery.