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Research highlights need for post-operative system of care for elderly

A significant gap exists in the provision of care for elderly patients who undergo emergency abdominal surgery, according to research published by RCSI’s Healthcare Outcomes Research Centre (HORC).

Published in BMC Geriatrics, the study reviewed 4,951 hospital episodes of patients over 65 years admitted for emergency abdominal surgery.

The study revealed that the post-operative length of stay was almost two weeks longer for patients admitted from home and discharged to a nursing home in comparison with patients discharged home, reflecting more serious illnesses among patients discharged to nursing homes as well as indicating that patients who are fit to leave hospital may not have access to a step-down nursing home place.

90 per cent of older people who underwent emergency surgery were admitted from home. Just 60.8 per cent of those returned to their home on discharge from hospital. Of the patients admitted from a nursing home, 80.6 per cent were discharged back to a nursing home and 18.4 per cent died, probably reflecting their greater levels of frailty compared to those well enough to live at home.

“An increasing number of elderly patients undergo emergency abdominal surgery which reflects demographic change, longer life expectancy, and greater acceptance of emergency operative management in older people,” said National Clinical Programme in Surgery Co-Lead and senior author on the paper Professor Deborah McNamara.

“Older patients who undergo emergency abdominal surgery are often frail and have complicating underlying medical conditions which increases the risk associated with these operations and makes their recovery more complex. Older patients are vulnerable to post-operative functional decline that can impact their quality of life and their ability to live independently. This is especially true for patients who have prolonged stays in hospital.”

The annual National Healthcare Conference, hosted by HORC, takes place at RCSI on Tuesday, 31 March.

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