Abstract
Abstract
Background
Intra-abdominal emergency surgery is associated with high mortality risk and long length of hospital stay. The objective of this study was to explore variations in surgery rates, the relationship between admission source and discharge destination, and whether the postoperative length of stay was related to nursing home capacity in Irish counties.
Methods
Data on emergency hospital episodes for 2014–18 for patients aged over 65 years with a primary abdominal procedure code were obtained from the National Quality Assurance Improvement System. Data on population and nursing home capacity were obtained from the Central Statistics Office and the Health Information and Quality Authority. Episode rates per 100,000 were estimated for sex and age groups and compared between 26 Irish counties. The association between admission source and discharge destination was explored in terms episode numbers, length of stay and mortality. A negative binomial regression model estimated casemix adjusted excess post-operative length of stay. The correlation between excess post-operative length of stay and nursing home capacity was explored by linear regression.
Results
Overall, 4951 hospital episodes were included. The annual surgery rate ranged from 100 episodes per 100,000 65–69 years old to 250 per 100,000 85–89 year old men. 90% of the episodes were admitted from patients’ home. Four in five of these patients returned to their home while 12.7% died at hospital. The proportion of episodes where patients returned to their home reduced to two in five for those aged 85–89 years. The post-operative length of stay was 13.6 days longer (p < 0.01) for episodes admitted from home and discharged to nursing home in comparison with episodes discharged home. A negative association (p = 0.08) was found between excess post-operative length of stay and county-level nursing home capacity.
Conclusions
This study provides relevant information to support informed consent to surgery for patients and clinicians and to improve the provision of care to older patients presenting with intra-abdominal emergencies.
Publisher
Springer Science and Business Media LLC
Subject
Geriatrics and Gerontology
Reference24 articles.
1. Turrentine FE, Wang H, Simpson VB, Jones RS. Surgical risk factors, morbidity, and mortality in elderly patients. J Am Coll Surg. 2006;203(6):865–77.
2. Parmar KL, Law J, Carter B, Hewitt J, Boyle JM, Casey P, Maitra I, Farrell IS, Pearce L, Moug SJ. Frailty in older patients undergoing emergency laparotomy: results from the UK observational emergency laparotomy and frailty (ELF) study. Ann Surg. 2019.
3. Svenningsen P, Manoharan T, Foss NB, Lauritsen ML, Bay-Nielsen M. Increased mortality in the elderly after emergency abdominal surgery. Danish Med J. 2014;61(7):A4876.
4. Green G, Shaikh I, Fernandes R, Wegstapel H. Emergency laparotomy in octogenarians: a 5-year study of morbidity and mortality. World J Gastrointestinal Surg. 2013;5(7):216–21.
5. Saunders DI, Murray D, Pichel AC, Varley S, Peden CJ. U. K. Emergency Laparotomy network: variations in mortality after emergency laparotomy: the first report of the UK emergency laparotomy network. Br J Anaesth. 2012;109(3):368–75.
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