Older Patients' Recall of Goals of Care Discussions Following Emergency Abdominal Surgery

Older patients undergoing emergency laparotomy are overrepresented and are at risk of poor postoperative outcomes that may not align with their goals. Goals of care (GOC) documentation remains low in older emergency laparotomy patients.

We conducted a prospective cohort study of emergency laparotomy patients aged ≥ 70 years between February 2024 and April 2025. Participants received phone follow-up 30 days after index surgery, assessing postoperative outcomes, EQ-5D-5L quality of life and decision satisfaction. If patients lacked capacity, next of kin were consented. Our primary aim was to assess recall of a preoperative GOC discussion. Our secondary aims were to correlate GOC recall with postoperative quality of life and decision satisfaction, and to determine rates of documented GOC conversations and GOC form completion.

We recruited 80 participants and completed follow-up in 75. Twenty-nine (39%) participants recalled discussing GOC preoperatively. Next of kin had higher recall than patients (n = 13, 59% and n = 16, 30% respectively). GOC recall was not associated with quality of life or decision satisfaction questionnaire scores. Most patients (n = 31, 89%) in the "GOC recall" group reported that the GOC conversation was worthwhile. Although 89% (n = 71) of participants had a completed GOC form preoperatively, 49% (n = 39) had a documented GOC discussion. We observed documentation inconsistencies, as participants with no GOC documentation recalled GOC discussions.

GOC recall by older patients and their next of kin was low following emergency abdominal surgery. GOC discussions were valued by patients and next of kin, supporting further research.