Aim 

To evaluate whether care by Medicine for Care of Older Person (MCOP) physicians reduced mortality and length of stay for patients over the age of 70 undergoing emergency abdominal surgery. 

Background

The perioperative path for older patients undergoing emergency general surgery can be particularly challenging and they have both a higher mortality and morbidity rate and a longer length of stay than their younger counterparts.

Methods

This was a prospective observational, before-and-after quality study carried out in four acute hospitals in the UK. Data was collected on all patients over the age of 70 undergoing emergency laparotomy between January 25th 2016 and June 25th 2016. During that time, purely observational data was collected on that specific group of patients. No run-in period was observed. Proactive care by an MCOP physician was introduced between June 26th 2016 and October 31st 2016. In addition, for both groups, health-related quality of life (HRQoL) data was collected at baseline, point of discharge from the acute hospital and at two, four and six months after the patient’s acute hospital discharge. 

Results

Two hundred and thirteen patients underwent emergency laparotomy in the four centres; 98 in the pre-implementation group and 115 patients in the implementation group. There was no significant difference in in-hospital mortality or length of stay between the two groups. 

The implementation group reported a better quality of life four months after their emergency surgery with an improvement in their QALY by 0.08. 

Conclusion

Whilst in-hospital mortality or length of stay did not change, quality of life improved after discharge from hospital after the introduction of an MCOP physician perioperatively. With integrated care systems, and joint hospital and community planning, health policy should focus on developing a shared service between general surgeons and geriatricians.