Abstract
Introduction NELA (National Emergency Laparotomy Audit) and British Geriatric Society guidance states patients aged ≥ 80 years, or ≥ 65 years and frail, should have a comprehensive geriatric assessment (CGA) from a perioperative frailty team within 72 hours of admission or critical care step-down. Patients aged ≥ 65 years represented 55.3% of those undergoing emergency laparotomy; and frailty doubled the mortality rate in this group, but post-operative geriatrician review was associated with reduced mortality (NELA project team, RCoA, 2023).
Method The Perioperative Care of Older People Undergoing Surgery (POPS) service was established in our trust in October 2020 in response to NELA recommendations. Over three years our service has grown from one whole-time equivalent geriatrician and one 0.6WTE nurse practitioner, to a team of six, adding a clinical nurse specialist, physician associate, junior clinical fellow and memory link worker. With staff training, all surgical admissions aged ≥ 65 are screened for frailty to enable identification of patients who will benefit most from CGA and subsequent support during the admission. An internal database was established to prospectively capture patient demographics and outcomes.
Results Added team capacity has allowed us to see more patients year-on-year, including more patients not requiring laparotomy. Median frailty score and age have increased from 5 to 6, and 77 to 80 years, respectively, without a significant change in median length of stay. Mean trust compliance with NELA guidance around geriatrician review has improved significantly from 3% to 88% post POPS establishment.
Conclusions Introduction and expansion of a POPS service at our trust has resulted in an increased number of patients receiving geriatrician-led CGA, though meeting 100% of NELA standard likely requires a second consultant or cross-cover arrangement. However, we are reviewing more patients, who are on average older and frailer, without an increase in length of stay.