Shipway David, Koizia Louis, Winterkorn Nick, Fertleman Michael, Ziprin Paul, Moorthy Krishna
North Bristol NHS Trust, Bristol, UK.
Imperial College Healthcare NHS Trust, London, UK.
Future Healthc J. 2018 Jun;5(2):108-116. doi: 10.7861/futurehosp.5-2-108.
The older surgical patient is well known to be at high risk of increased mortality and medical complications in the perioperative period. These occur due to a variety of patient and service related factors. The need for physician support is recognised and liaison models of care can reduce complications and length of stay (LOS) in some surgical specialties. Limited evidence exists evaluating their role in emergency and planned gastrointestinal surgery. We aimed to establish and evaluate a geriatric surgical liaison service for emergency and elective gastrointestinal surgery. We found that embedded geriatrician liaison and process change throughout the surgical pathway was associated with a mean LOS reduction of 3.1 days for all surgical patients aged >60 years (p=0.007). Mean LOS reduction for emergency surgical admissions aged >60 was 4.4 days (p=0.005). Embedded geriatric surgical liaison models of care can be successfully adapted for emergency general and gastrointestinal surgery. In times of financial constraint, reductions in LOS may make modest investment in similar services economically viable.
众所周知，老年外科患者在围手术期死亡率增加和出现医疗并发症的风险很高。这些情况的发生是由于多种与患者和服务相关的因素。人们认识到需要医生的支持，并且在某些外科专科中，联络护理模式可以减少并发症和缩短住院时间（LOS）。评估它们在急诊和计划性胃肠手术中作用的证据有限。我们旨在为急诊和择期胃肠手术建立并评估老年外科联络服务。我们发现，在整个手术过程中嵌入老年医学专家联络和流程变革与所有60岁以上手术患者的平均住院时间减少3.1天相关（p = 0.007）。60岁以上急诊手术入院患者的平均住院时间减少4.4天（p = 0.005）。嵌入的老年外科联络护理模式可以成功地应用于急诊普通外科和胃肠手术。在财政紧张时期，住院时间的缩短可能使对类似服务的适度投资在经济上可行。
