Abstract
Aim
Emergency laparotomy is associated with a high mortality and morbidity. Early identification of high-risk patients allows for timely involvement of other members of the multidisciplinary team, including care of the elderly (CoE) specialists. This improves the likelihood of a successful post-operative recovery. This study investigated the adherence to the NELA guidelines regarding the use of the clinical frailty score and input from the CoE team.
Methods
A prospective analysis was conducted, collating data on patients undergoing an emergency laparotomy in one centre in East London. Data collected included the date of admission, findings at operation, clinical frailty scores, and input from CoE team members.
Results
16 patients had an emergency laparotomy during May 2024. Ages ranged from 44 to 92. 11 patients were aged 65 years or older but none had a clinical frailty score within 4 hours of admission, as per NELA guidelines. 6/11 (55%) were reviewed post-operatively by the CoE team during their inpatient stay. These findings were reported at the monthly morbidity and mortality meeting. Our interventions included a surgical teaching session, posters in the department and a stamp for CoE review kept in CEPOD theatre for use post-laparotomy. The second cycle showed significant improvement with a 33% increase in CFS and a 12% improvement in care of the elderly reviews.
Conclusions
In conclusion, it is known that older patients have a poorer post-operative outcome, which is improved by perioperative CoE input. With this audit, we improved awareness within our department regarding older, frail patients and began to see a change regarding assessing patients mobility and need for CoE input. However, we are still not doing this for all of our patients so there are still improvements to be made. Interestingly, in terms of interventions, we found that teaching and discussion had the greatest impact.