Does a Dedicated Frailty Service Improve Outcomes for Emergency Laparotomy in Elderly Patients?

Introduction:With improvements in medical care, more and more patients are surviving into old age. Elderly patients presenting with abdominal surgical emergencies constitute the majority of an emergency surgeon’s workload. Recently, there has been a lot of interest in improving surgical outcomes for frail and elderly patients needing emergency laparotomies. We carried out a prospective audit to investigate the impact of having a dedicated frailty service on the post-operative outcomes of such frail elderly patients. Materials and Methods: Our audit included all elderly patients (defined as > ۶۵ years of age at the time of surgery) undergoing emergency laparotomy for a period of six months from January to June ۲۰۲۱ in our ۷۰۰-bed acute care hospital in the UK. Post-operative outcomes were ۳۰ and ۹۰-day mortality, length of stay in hospital, and proportion of patients discharged to their own home after surgery. Results: Our data demonstrates that the availability of such a dedicated frailty service does significantly decrease the proportion of patients discharged to their own homes and the rate of readmissions after emergency laparotomies. Length of stay, ۳۰ and ۹۰ day mortalities decreased to a non-significant level. Conclusion:Therefore, establishing a dedicated frailty service for both preoperative optimization as well as improving post-operative care is an important step to improving outcomes for this group of high-risk surgical patients.

Keywords:

Emergency laparotomy , Frailty , Length of stay , Mortality , readmission