O054 Return to pre-hospital residence following emergency laparotomy

Abstract

Abstract Introduction Poor outcomes following emergency laparotomy include death and the loss of independent living. A widely-held apprehension is the ‘salvage’ of a previously independent patient, only to render them reliant on long-term dependent care. We aimed to establish the proportion of patients who returned to their pre-hospital residence following emergency laparotomy, measured at discharge, 90 and 365 days. Methods Data was collected on all patients over 18 years of age who underwent emergency laparotomy across four Australian hospitals between 1 January 2018 and 31 December 2019. Data recorded included pre-hospital residence, discharge destination, mortality and place of residence at 90 and 365 days. Results 782 patients underwent an emergency laparotomy during the study period. The mean age was 64 years (range 18-96). Prior to hospital admission, 95.5% of patients lived in their own home, while the remainder resided in supported living facilities. 7% of patients died during their hospital admission. Of those alive on discharge, 77.6% were discharged to their pre-hospital residence. At 90 days, mortality was 10.6% while 97.1% of surviving patients had returned to their pre-hospital residence. By 365 days, mortality was 17.0% while 98.0% of surviving patients had returned to their pre-hospital residence, and 94.0% were living in their own home. Conclusion Patients who survive 90 and 365 days following emergency laparotomy nearly all return to their pre-hospital residence, with only a small proportion of previously independent patients entering dependent care. This should inform shared decision-making regarding emergency laparotomy in the acute setting.