159 / 210
Poster presentations / European Geriatric Medicine 6S1 (2015) S32
–
S156
S151
Results:
Preoperatory stay, presence of surgical wound infection
and the need for pre-existing disease control are the main
predictors of long-stay.
The risk of in-hospital mortality has been influenced by age,
polypharmacy and the highest degree of prior dependence. Age
over 85, high comorbidity and polypharmacy is associated with
more complications.
The ASA
>
III, previous diagnosis of dementia and more than
72 hours of surgical’s time delay was associated with more
complications and more drugs at discharge.
A greater number of drugs at discharge was associated with higher
frequency of institutionalization.
The application of multidisciplinary protocols provides a decrease in
hospital mortality and increased detection of complications during
admission, keeping the same number of drugs at discharge and
lower gross rate of infections.
Conclusions:
The identification of factors associated with a worse
outcome for these patients should be used to neutralize them, been
one of the working pillars of the orthogeriatric model
P-443
Frailty seems a better guideline for selection of patients
eligible for geriatric assessment rather than type of fracture
T.L. Smith
1
, M. Midttun
2
1
University Hospital of Herlev, Herlev, Denmark;
2
Department of
Medicine, and Geriatrics O, Copenhagen University Hospital, Herlev,
Herlev, Denmark
Objectives:
The objective of this study is to investigate the selection
of patients admitted to the orthopedic unit regarding geriatric
assessment. Is the current selection based on femoral neck fracture
adequate or are better criteria needed?
Methods:
Data was obtained retrospectively from charts of 127
patients, 65 years and older admitted to the orthopedic unit,
Copenhagen University Hospital, Herlev, September 2014 to October
2014, regardless of cause of admission. Mean age 81.7 years, 91
female and 36 male. A modified frailty index (MFI) of 11 different
frailty indicators was used to asses if the current selection resulted
in the right patients getting geriatric attention.
Results:
Mean frailty score was 3.17. The hit-rate of geriatric
assessment was 51.6%, and of the 40 geriatric assessments made,
7 were done outside the hip-fracture unit. A geriatric assessment
was made in 75% of the 53 patients with a frailty index value above
the cut-off of 3.5.
Conclusions:
There seems to be a need for better selection of
patients in regards to geriatric assessment. On admission to the
orthopedic ward, a number of criteria should be addressed in
selecting who is eligible for a geriatric assessment. The current
selection that only takes patients with a femoral neck fracture into
account leaves us seeing only 75% of those in need for a specialist
in geriatric medicine. Furthermore with a hit-rate of only 51.6% the
capacity to see all of those in need is there, but could be used more
efficiently.
Financial support from commercial parties:
None.
P-444
Emergency laparotomy in the older patient. Perioperative care
of older people undergoing surgery
–
Salford General Surgery
(POPS-SG)
T. Thorpe
1
, A. Vilches-Moraga
2
, J. Fox
2
, E. Feilding
2
, M.K. Peeroo
2
,
K. Wardle
2
, Z.R. Alio
2
1
Salford Royal NHS Foundation Trust, Salford, United Kingdom;
2
Salford Royal NHS Foundation Trust, Salford, Manchester, United
Kingdom
Objectives:
The purpose of our study was to describe the
characteristics of a cohort of elderly patients undergoing emergency
laparotomy and elderly care in reach input.
Methods:
We carried out a prospective interventional non-
randomised study of frail older adults requiring surgical admission.
All individuals underwent comprehensive geriatric assessment,
targeted multidisciplinary interventions and discharge planning.
Results:
Between September 6th 2014 and March 31st 2015 a total
of 17 individuals endured emergency laparotomy. Mean age was 82
years (72–97), 9 were females, 9 lived alone (5 on discharge), 5 with
a spouse (4 on discharge), 1 in residential, and 2 in a nursing home.
Ten patients mobilised with no aids, 3 used a cane, 3 walking frame
and one required hoisting. Four required help with basic activities of
daily living (ADL) and 7 with instrumental ADL. They presented on
average 4 (0–7) comorbidities; hypertension (14), anaemia (7) and
renal impairment (6) being the most frequent. The most common
complaint was abdominal pain (10); whilst complicated hernia (8)
and colonic cancer (4) were the most frequent diagnosis. Average
medications on admission were 9 (3–15) and 7 (3–13) on discharge.
Heparin was used in all patients and antibiotics in 16. Complications
included anaemia (12), constipation (10), delirium (7) and acute
renal impairment (7). Discharge was delayed in 4 cases; length of
stay was 20 days (6–50), 2 individuals died in hospital (11.7%) and
one more within 30 days.
Conclusions:
Older persons undergoing emergency laparotomy
present significant comorbidity, polypharmacy, multifactorial
aetiology and high morbi-mortality.
P-445
Clinical outcomes of older persons admitted to general surgical
wards. Perioperative care of older people undergoing surgery
–
Salford General Surgery (POPS-SG)
T. Thorpe
1
, A. Vilches-Moraga
2
, J. Fox
2
, M.K. Peeroo
2
, E. Feilding
2
,
Z.R. Alio
2
, K. Wardle
2
1
Salford Royal NHS Foundation Trust, Salford, United Kingdom;
2
Salford Royal NHS Foundation Trust, Salford, Manchester, United
Kingdom
Objectives:
The purpose of our study was to establish factors
associated to increased morbidity and mortality during hospital
stay and at 30 days post discharge.
Methods:
This is a prospective study of older adults
requiring surgical admission (general surgery, colorectal or
upper gastrointestinal). All individuals underwent comprehensive
geriatric assessment, targeted multidisciplinary interventions and
discharge planning.
Results:
Between September 6th 2014 and March 31st 2015 a total
of 161 consecutive patients with a mean age 81.5 years (70–97)
were assessed by our in reach team.
The most common complications included anaemia (50%),
constipation (47%), delirium (27%) and acute kidney injury (24.8%).
A total of 27 discharges were delayed for a non-medical reason
and length of stay was 25 (3–70) in this group. Length of stay was
also longer in elective admissions and surgery, particularly elective
laparotomy. Univariate analysis revealed different factors associated
with in-hospital mortality including: old age, diagnosis of cancer,
dementia, delirium and functional decline during admission. Seven
patients died within 30 days of discharge (4.96%). Mean age was
79 years (71–86), six lived in the community, 2 had dementia, 5
cancer diagnosis and 4 comorbidities on average (2–8). Length of
stay was 23 days (9–63). At 30 days, 27 patients were readmitted to
hospital (17.6%) either electively (ERCP 4 patients, 1 nasojejunal feed
tube insertion) or as emergencies for management of complications
(wound infection, ileus) or cancer progression.
Conclusions:
Comorbidity, delirium and functional impairment are
potentially reversible factors that increase in-hospital mortality and
should be managed adequately.