干旱区生态环境知识资源中心(Arid): Emergency laparotomy in older adults with geriatric medicine input implications of demographics, frailty and comorbidities on outcomes

Arid

DOI	10.1111/ans.19107
	Emergency laparotomy in older adults with geriatric medicine input implications of demographics, frailty and comorbidities on outcomes
	Teh, Ryan; Teo, Serene; Trivedi, Anand; Kumarasinghe, Anuttara Panchali
通讯作者	Teh, R
来源期刊	ANZ JOURNAL OF SURGERY
ISSN	1445-1433
EISSN	1445-2197
出版年	2024
卷号	94 期号:7-8 页码:1365-1372
英文摘要	BackgroundWe (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.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.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. We present an original research on emergency laparotomy in older adult patients in a single-centre tertiary hospital, where we have successfully integrated a geriatrician-led perioperative care service into our acute surgical unit. We describe outcomes from our cohort of older adult patients undergoing emergency laparotomy, and explore the implications of age, comorbidity and frailty. We present a different perspective towards the way we view and manage older adult surgical patients, in order to ensure improved overall outcomes. image
英文关键词	emergency laparotomy general surgery older adult perioperative medicine
类型	Article
语种	英语
收录类别	SCI-E
WOS记录号	WOS:001240500200001
WOS关键词	SURGERY ; PATIENT ; SCALE
WOS类目	Surgery
WOS研究方向	Surgery
资源类型	期刊论文
条目标识符	http://119.78.100.177/qdio/handle/2XILL650/402842
推荐引用方式 GB/T 7714	Teh, Ryan,Teo, Serene,Trivedi, Anand,et al. Emergency laparotomy in older adults with geriatric medicine input implications of demographics, frailty and comorbidities on outcomes[J],2024,94(7-8):1365-1372.
APA	Teh, Ryan,Teo, Serene,Trivedi, Anand,&Kumarasinghe, Anuttara Panchali.(2024).Emergency laparotomy in older adults with geriatric medicine input implications of demographics, frailty and comorbidities on outcomes.ANZ JOURNAL OF SURGERY,94(7-8),1365-1372.
MLA	Teh, Ryan,et al."Emergency laparotomy in older adults with geriatric medicine input implications of demographics, frailty and comorbidities on outcomes".ANZ JOURNAL OF SURGERY 94.7-8(2024):1365-1372.