Emergency laparotomy in older adults with geriatric medicine input: implications of demographics, frailty and comorbidities on outcomes

Abstract

AbstractBackgroundWe (1) describe West Australian (WA) older adults undergoing emergency laparotomy (EL) in a tertiary‐centre Acute Surgical Unit (ASU) with proactive geriatrician input and (2) explore the impact of Clinical Frailty Scale (CFS) and Charlson's Comorbidity Index (CCI) on patient outcomes.MethodsWe performed a prospective cohort‐study of older adults undergoing EL, between April 2021 and April 2022, in a tertiary ASU, with dedicated geriatrician‐led perioperative care via the Older Adult Surgical Inpatient Service (OASIS).ResultsOf 114 patients, average age was 76.7 ± 7.61 years‐old (range 65–96), with 35.1% (n = 40) frail (CFS 5–7), 18.4% (n = 21) vulnerable (CFS 4) and 46.5% (n = 74) not frail (CFS 1–3). 61.4% (n = 70) were severely comorbid (CCI ≥5), 34.2% (n = 39) moderately comorbid (CCI 3–4), and 4.4% (n = 5) mildly comorbid (CCI 1–2).95.9% (n = 109) EL patients were reviewed by OASIS.Inpatient mortality was 7.9% (n = 9) and 1‐year mortality 16.7% (n = 19). Majority, 64.9% (n = 74), were discharged directly home with 17.5% (n = 20) discharged with in‐home rehabilitation. Each increment in CCI was associated with increased in‐hospital (HR 1.38, p = 0.034) and 1‐year (HR 1.39, p = 0.006) mortality, and each increment in CFS with 1‐year mortality (HR 1.62, p = 0.016). Higher CFS but not CCI was associated with increased level of care at discharge. Age was not statistically significant with any outcomes.ConclusionWe describe demographics, frailty and comorbidity of 114 older adults undergoing EL in ASU. We suggest CFS and CCI as independent risk‐stratification tools, and proactive management of both comorbidity, and frailty, should be incorporated into preoperative optimisation.