throughout May and June 2013 and May and June. 2014. Baseline data were ... Report of the National Confidential Enquiry into Peri-Operative Deaths. London:.
Do Older Surgical Patients Who Undergo Emergency Operation Have Higher Mortality And Readmission Compared To Those Managed Conservatively? HS TAY 1, AD WOOD 2, J HEWITT 3, L PEARCE 4, SJ MOUG 5, K McCARTHY 6, MJ STECHMAN 7, PK MYINT 1, 2 1. Aberdeen Royal Infirmary, Aberdeen, UK 2. University of Aberdeen, Aberdeen, UK 3. Cardiff University, Cardiff, UK 4. Manchester Royal Infirmary, Manchester, UK 5. Royal Alexandra Hospital, Paisley, UK 6. North Bristol NHS Trust, Bristol, UK 7. University Hospital of Wales, Cardiff, UK
Introduction: Current demographic trends show that the population of the United Kingdom is ageing. The number of older (≥65 years) people presenting with acute surgical problems is predicted to increase. It is currently unclear whether mortality at 90 days following hospital admission or hospital readmission within 30 days of discharge are different in older emergency surgical patients who undergo operation compared to those managed conservatively. We therefore examined whether the approach to patient management (operation or conservative treatment) in a cohort of older emergency surgical patients affected mortality at 90 days post-admission or hospital readmission within 30 days of discharge.
characteristics (frailty and polypharmacy) between operated and conservatively managed patients. We found no association between operation and outcomes of 90-day mortality (adjusted odds ratio (AOR) (95%CI) = 0.64 (0.30-1.41); P=0.27) or hospital readmission within 30 days after discharge (AOR = 1.08 (0.65-1.77); P=0.77).
Methods: Data were employed from the Older Persons Surgical Outcomes Collaboration (www.OPSOC.eu) (2013 and 2014) to assess the prevalence of operations and conservative treatment in older emergency surgical admissions. The five participating sites were Aberdeen, Bristol, Cardiff, Glasgow and Manchester. The cohort comprised of consecutively admitted patients aged ≥65 years old, who presented to the acute general surgical unit of each study site throughout May and June 2013 and May and June 2014. Baseline data were collected on age, gender, polypharmacy, haemoglobin, albumin, and frailty.
We have shown that the mortality of older surgical patients at 90 days and readmission within 30 days following hospital admission is not associated with choice of management strategy. This highlights the requirement for optimal management of all acute older surgical admissions. Provision of comprehensive geriatric assessment may have central role in optimising the care and outcomes of older people in the acute surgical setting.
Frailty was measured using the validated 7-point Canadian study of health and ageing clinical frailty score (CSHA) (Box 1) and categorised into three groups; very fit (1-2); frail (3-4); and very frail (5-7)1. Albumin ≤35 g/L was classified as low. Haemoglobin ≤129 g/L was classified as low. Polypharmacy was defined as regular use of ≥ 5 medications. The association between operative treatment and both mortality at 90 days post-admission and hospital readmission within 30 days of discharge was examined using multivariate logistic regression (with conservative management as the reference category in the models). Our analyses were adjusted for age, gender, polypharmacy, haemoglobin, albumin, and frailty. Results: A total of 727 patients [mean age (SD) = 77.1 (8.2) years, 54% female] were included in this study. Of them, 185 (25%) underwent emergency operation. Patients that received an operation were younger than those who did not [76(7.7) vs. 78(8.4) years; P
