Surgical referrals from nursing homes; More evidence for a geriatric medicine liaison service

Abstract

s / International Journal of Surgery 10 (2012) S53–S109 S90 ABSTRACTS 0962: SURGICAL REFERRALS FROM NURSING HOMES; MORE EVIDENCE FOR A GERIATRIC MEDICINE LIAISON SERVICE Daniel Burchette, Gagandeep Grover, Michael Booth, Margot Gosney. Royal Berkshire NHS Foundation Trust, Berkshire, UK Aims: To assess outcomes of inpatient stay in patients referred to acute surgical unit from residential homes, comparing with non-institutionalised patients with similar presenting complaints. Methods: 40 patients admitted from homes over six months were matched with following emergency surgical admission living independently aged >70. Data gathered via ‘take’ lists and discharge summaries. Results: Dementia was more prevalent in the residential care (45 vs. 28%), who also had more co-morbidities (4.4 vs. 2.6). Presenting complaints between groups were similar, abdominal pain and haematemesis being leading causes. Larger proportion of community residents underwent surgery during admission (28 vs. 5%) whilst greater proportion of residential care died during admission (15 vs. 2.5%). Residential care patients had a slightly longer average duration of stay in this study (5.5 vs 4.2 days). Conclusions: Whilst presenting with similar complaints, residential care patientsare lessoftensurgical candidates; fewerundergosurgeryanda larger proportion die during admission. This supports value of geriatric liaison, particularly discharge planning, including in those patients palliative needs, aswell asmedical optimisationof co-morbiditieswhensurgery is considered. Presented to the surgical and elderly care department: a new admission pathway for this group of patients was proposed to the trust, suggesting refferal via the geriatric team. 1045: OUTCOMES FOLLOWING EMERGENCY GENERAL SURGERY IN NONAGENARIANS Tim Sparkes, Gregory Jones, Charles Evans. Buckinghamshire Healthcare NHS Trust, Stoke Mandeville, UK Aim: In 2010 NCEPOD highlighted concerns over outcomes of elderly patients undergoing emergency surgery. This study aimed to investigate outcomes in nonagenarians undergoing emergency surgery and identify predictive risk factors for mortality and the impact on care requirements. Method: All nonagenarian patients who underwent emergency general surgery operations between June 2005 and June 2010 within one NHS Trust were retrospectively reviewed. Risk factors analysed included age, sex, ASA grade, clinical parameters, preoperative blood tests (including Creactive protein (CRP)), preoperative care dependence, operation factors and surgeon factors. Kaplan-Meier survival analysis was performed using one year mortality rates. Results: Forty six patients (30 female) underwent surgery with an inpatient mortalityof32.6%andoneyearmortalityof54.3%.Patientsundergoingmajor index surgery, a CRP> 100 or who required any form of preoperative social care had significantly reduced survival (P1⁄4 0.013, P 100, requirement for social care preoperatively and major index surgery. 1096: LAPAROSCOPIC APPENDICECTOMY – A NEGATIVE IMPACT ON EMERGENCY OPERATING? Elisabeth Royston, Catherine Bradshaw, Peter Budny, Shaun Appleton. Stoke Mandeville Hospital, Aylesbury, UK Background: Acute appendicitis is commonly managed with laparoscopic appendicectomy. However, there is a perception that it takes longer than an open operation and may, therefore, impact on the efficiency of emergency operating lists. The purpose of this study was to 1) evaluate the increase in laparoscopic appendicectomies over a five year period; 2) assess whether operating times are increased and 3) identify how this effects the provision of emergency operating lists. Methods: Data was collected retrospectively for all appendicectomies performed in a single NHS trust from 2006 to 2011 and analysed over three time periods. Results: The total number of appendicectomies performed annually ranged from 336 to 399. The percentage performed laparoscopically has progressively increased from 9% in 2006 to 56% in 2011. The average time taken to perform a laparoscopic appendicectomywas eight minutes longer than for an open procedure (p<0.001). The average duration of laparoscopic appendicectomy has not changed since 2006. Conclusion: Although laparoscopic appendicectomies took consistently more time than open appendicectomies, the average difference was only eight minutes. Given the average number of appendicectomies performed per day is one, it is unlikely this increased operating time will negatively impact on the provision of emergency surgery. 1129: IS THE USE OF LAPAROSCOPY LEADING TO A RISE IN THE NEGATIVE APPENDICECTOMY? AmyWhiteford, Carole Neff, James Mansell. Hairmyres Hospital, Hairmyres,