Background and Goal of Study:

Patients undergoing emergency bowel surgery (laparotomy) have approximately an 11% mortlaiyt rate in England and Wales, and higher in some centres across Europe. Elderly patients have an even higher mortality rate at approximately 20% in England.  A quality improvement project was run in four hospitals in the South of England to deliver prospective care for patients over the age of 70 undergoing emergency laparotomy using a similar model to orthogeriatrics. 

Materials and Methods:

Baseline data was collected initially on patients who were over the age of 70 and undergoing an emergency laparotomy for 6 months. Then, prospective care was delivered by a geriatrician to patients who came in requiring similar emergency bowel surgery. Data was recorded in each group incuding frailty scores, pain scores, and post-operative morbidity scores. Length of stay and in hospital mortality was recorded. 

Results and Discussion:
25% of baseline patients were seen by Medicine of Care of Older People (MCOP) physicians as 'crisis management'.
Mortality was reduced but was not statistically significant. 

Length of stay was reduced by 4 days which was statistically significant. 
There was an increased use of allied health care professionals and use of intermediate rehabiliation hospitals for patients who were seen by geriatricians prospectively. 

Shared, prospective care by  MCOP physicians for elderly surgical patients gives more holistic care to the patient and allows the patient to be discharged quicker out of an acute hospital. There is less 'crisis' management with on-call medical physicians reviewing patients on an ad-hoc basis. 

Conclusion(s):
Proactive MCOP physicians should be employed to offer care to emergency elderly general surgical patients who have a high risk of mortality and morbidity.

08 / Medicine for Care of Older People and Emergency Laparotomy: The Lessons and How We Can Improve Care?