Aims. To describe older adults undergoing emergency laparotomy (EL) in a tertiary acute surgical unit (ASU), receiving proactive geriatric medicine input.
Methods: Baseline clinical data prospectively collected on older adults (over 65-years), receiving proactive geriatric medicine input via Older Adult Surgical Inpatient Service (OASIS). Business data identified all EL performed over 12-months, from April 2021. Outcome data assessed via review of electronic medical record.
Results: Of 114 older adults undergoing EL in our ASU, 96%(n=109) had OASIS review.
Of those reviewed, average age was 76.75±7.61 years (range 65-96). Majority were from home 99.1%(n=108) and mobilised independently 67.9% (n=74). 11%(n=12) used a walking-stick, 8.3% (n=9) walking-frame and 12.8%(n=14) four-wheeled-walker. Medical comorbidities included hypertension, ischemic heart disease, congestive cardiac failure, obstructive airway disease and diabetes. 32.1%(n=35) had atrial fibrillation, with 82.9%(n=29) on anticoagulation. 12.8%(n=14) were severely frail (clinical frailty score (CFS) 6-9,), 40.3%(n=44) mildly frail (CFS 4-5) and 46.8%(n=51) not frail (CFS 1-3).
OASIS was involved in medication changes, goals of care decisions, anticoagulant and antiplatelet management, perioperative risk assessment and discharge planning.
In hospital mortality was 6.4%(n=7). Average length of stay 13.99±13.59 days (range 4-97), and 29.4%(n=32) required intensive care. 67.9%(n=74) were directly discharged home, 25.7%(n=26) requiring home rehabilitation. 26.6%(n=29) required inpatient rehabilitation. 16.5%(n=18) were readmitted within 30-days, and a further 11%(n=12) within 90-days.
Conclusion: 96% of all older adults undergoing EL in our ASU were reviewed by OASIS. Older adults undergoing EL at our institution have frailty, medical comorbidity and requirement of rehabilitation post-operatively, where proactive geriatric medicine can optimise patient care.