ThTP8.4 What is the longer-term impact of emergency laparotomy for older people living with frailty? A mixed-methods study protocol

Abstract

Abstract Introduction A third of emergency laparotomies performed in the United Kingdom (UK) are in older people living with frailty (OPLWF). Despite high risk of adverse clinical outcomes for this group, there is a lack of research into patient experience. Longer-term outcomes have also not been fully explored. This data is essential in enabling informed shared decision making and robust post-operative care tailored to the holistic needs of this group. Study aim This study aims to understand the impact of emergency laparotomy for OPLWF in two ways. Qualitative interviews will explore patient experience following surgery. A retrospective analysis of the National Emergency Laparotomy Audit (NELA) database will examine longer-term outcomes including death and hospital readmission. Methods Phase One: 30 participants (≥ 65yrs, CFS ≥ 5) are being recruited from hospital sites across the UK to undertake interviews within one month of surgery. Data is being analysed using thematic analysis. The results will enable targeted data collection in phase two. Phase Two: 12 participants (≥ 65yrs, CFS 5/6) will be recruited to undertake interviews at 3-, 6- and 12-months. Longitudinal Interpretative Phenomenological Analysis will facilitate in-depth understanding of lived experience following surgery. In the NELA analysis, the primary outcome measure will be time to all-cause mortality, secondary outcome measure will be time to hospital readmission. The results from phase one are expected by April 2023. Discussion This study will provide much needed knowledge of longer-term impacts of emergency laparotomy for OPLWF, informing future service delivery and providing context to shared decision-making