SP9.5 - Peri-operative Comprehensive Geriatric Assessment (CGA): A new benchmark for Acute General Surgery patients

Abstract

Abstract Aims More than 50% of patients undergoing emergency general surgery are over 65 years of age. NICE guidelines emphasise frailty assessment in acute surgical settings, particularly in the preoperative period. Similarly, the Emergency Laparotomy and Frailty (ELF) study showed associations between frailty (CFS ≥ 5) and 90-day mortality, increased complication and length of hospital stay in older emergency laparotomy patients. NELA best practice tariff (BPT) April 2023 heavily focuses on perioperative team involvement in frailer, older patients. This is an audit from a city teaching hospital, with a surgical liaison team against standards set by NELA. Methods Review of patients aged ≥ 65 undergoing emergency laparotomies between August and November 2023 (pre-intervention) then December and January 2024 (post-intervention). Data collected includes whether patients had a documented frailty score, a clearly documented CPR decision & treatment escalation plan (TEP), pre- or post-operative medical review, and advanced-care planning (ACP) post-operatively. Intervention included dedicated members of surgical liaison team following patients throughout admission, weekly meetings to discuss laparotomy patients, older patient template being created capturing ceilings of care, frailty score, and social history. Results Post intervention, improvement in clear documentation regarding escalation, frailty level. Greater level of MDT collaboration with regards to older patients undergoing laparotomies. Conclusion Changes in NELA BPT emphasise the importance of comprehensive geriatric assessment in the management of older laparotomy patients. Even a basic surgical liaison service can achieve high levels of compliance with a few simple strategies, resulting in better outcomes for patients as well as financial benefits for Trusts.