Changes in social care after major emergency general surgery procedures

Area of Science:

• Geriatric Medicine
• Surgical Outcomes
• Healthcare Management

Background:

• Emergency general surgery (EGS) carries high risks of morbidity and mortality.
• Patients undergoing EGS often face challenges in returning to their previous level of independence.
• Discharge to residential or nursing homes is a significant concern for EGS patients previously living independently.

Purpose of the Study:

• To identify factors contributing to loss of independence post-EGS.
• To determine predictors for discharge to residential and nursing homes.
• To understand the long-term outcomes for patients after emergency general surgery.

Main Methods:

• Analysis of local data within the National Emergency Laparotomy Audit (NELA) from 2014-2022.
• Inclusion of patient demographics, ASA score, admission/discharge details, pathology, and operation type.
• Multivariable logistic regression to identify factors associated with nursing home placement.

Main Results:

• 1 in 10 patients over 70 did not return home after EGS.
• Patients needing additional support were significantly older (average 8.6 years).
• Risk of requiring extra support increased substantially with age, especially over 85; older patients were more likely to die.

Conclusions:

• A substantial number of elderly patients do not return home after EGS, requiring higher care levels.
• Age is a critical factor influencing discharge destination and need for support.
• Social and demographic factors must be considered pre-operatively due to quality of life and economic implications.