Khan Kashuf A, Subramanian Thejasvi, Richters Megan, Mubarik Ayesha, Saad Abdalla Al-Zawi Abdalla, Thorn Christopher C, Chalstrey Susan, Gunasekera Savithri
General Surgery, Royal Shrewsbury and Telford National Health Service (NHS) Trust, Shrewsbury, GBR.
General Surgery, Good Hope Hospital, University Hospitals Birmingham, Birmingham, GBR.
Cureus. 2020 Feb 21;12(2):e7069. doi: 10.7759/cureus.7069.
With the increasing median age of survival in the UK, there is an increased burden on the provision of medical and surgical care to the population. The 2010 National Confidential Enquiry into Patient Outcome and Death report, "An Age Old Problem," emphasizes the early involvement of surgical and geriatric consultant input to improve perioperative care in older patients. This study describes the development of a Geriatric Surgical Liaison Service aimed at providing consultant-led geriatrician support to improve the outcomes of older patients undergoing Emergency Laparotomy (EL). The primary outcome is the reduction in length of stay (LOS) compared to baseline data prior to geriatrician involvement. The service was designed to include one clinical session involving a consultant geriatrician and two and a half days with a junior doctor in a week. Data was collected prospectively from February 2018 till July 2018 for surgical patients aged ≥ 70 years, who underwent EL, had an inpatient stay of more than seven days, and who were diagnosed with delirium or incurred inpatient falls (intervention group). Baseline data, prior to geriatrician involvement, were collected retrospectively for EL patients aged ≥ 70 years from December 2015 until May 2016. Length of stay and 30-day mortality were also compared between the two cohorts undergoing EL. A total of 69 patients were included in the intervention group; 45 patients underwent EL and their mean LOS was 17.5 days, which was reduced from 22.5 days prior to geriatrician involvement (n=57). There was no difference in median length of stay and 30-day mortality between the retrospective baseline group and the intervention groups. In the intervention group, 8.5% of patients had a new medical diagnosis and 26.8% of patients were offered follow-ups. Although statistically not significant (p=0.40), a shorter stay in hospital by five days can potentially have a positive impact on patient outcomes by reducing psychosocial, cognitive, and functional deconditioning. This would also improve patient flow, release capacity, and waiting times and would be of benefit to the financially strained National Health Service (NHS). Overall, our study suggests that a collaborative, consultant-led geriatric service can improve the management of older surgical patients by potentially reducing length of stay, identifying high-risk patients, and facilitating early and appropriate specialty input alongside adequate and required outpatient follow-up.
随着英国生存年龄中位数的增加，为民众提供医疗和外科护理的负担也在加重。2010年《患者预后与死亡全国保密调查报告》“一个由来已久的问题”强调，外科和老年病学顾问应尽早参与，以改善老年患者的围手术期护理。本研究描述了老年外科联络服务的发展情况，该服务旨在提供由顾问主导的老年医学专家支持，以改善接受急诊剖腹手术（EL）的老年患者的预后。主要结果是与老年医学专家介入之前的基线数据相比，住院时间（LOS）缩短。该服务的设计包括每周一次由老年医学顾问参与的临床会诊以及与一名初级医生共处两天半的时间。前瞻性收集了2018年2月至2018年7月期间年龄≥70岁、接受急诊剖腹手术、住院时间超过七天且被诊断为谵妄或发生住院跌倒的外科患者的数据（干预组）。回顾性收集了2015年12月至2016年5月期间年龄≥70岁的急诊剖腹手术患者在老年医学专家介入之前的基线数据。还比较了两组接受急诊剖腹手术患者的住院时间和30天死亡率。干预组共纳入69例患者；45例患者接受了急诊剖腹手术，其平均住院时间为17.5天，较老年医学专家介入之前的22.5天有所缩短（n = 57）。回顾性基线组与干预组之间的住院时间中位数和30天死亡率没有差异。在干预组中，8.5%的患者有新的医学诊断，26.8%的患者获得了随访。尽管在统计学上不显著（p = 0.40），但住院时间缩短五天可能通过减少心理社会、认知和功能衰退对患者预后产生积极影响。这也将改善患者流量、释放床位并缩短等待时间，对资金紧张的国民医疗服务体系（NHS）有益。总体而言，我们的研究表明，由顾问主导的协作性老年医学服务可以通过潜在地缩短住院时间、识别高危患者以及促进早期和适当的专科介入以及充分且必要的门诊随访来改善老年外科患者的管理。
