Evaluating the need for an integrated geriatric service in older general surgery patients.

Abstract

Aim: To assess the viability of acute kidney injury (AKI) as a quality indicator in the care of older patients admitted under General Surgery.

Background: To improve the care of older surgical patients, an orthogeriatric model of care was developed. Despite the success of this model, there is a paucity of evidence in acute general surgical disciplines on the capacity of a similar service to reduce complications.

Method: A retrospective review of the medical records of patients aged 75 years and older admitted under General Surgery as emergency admissions between the 1st of July 2015 and the 30th of June 2018 at the Royal Hobart Hospital. Twenty randomly selected cases were reviewed by an expert panel to assess the preventability of AKI.

Results: Of 314 patients, the most commonly reported diagnosis was small bowel obstruction. Less than half of all patients underwent a surgical, radiological or endoscopic intervention. There were 32 (10%) cases of AKI; 13 (4%) had pre‐hospital and 19 (6%) had inpatient. Diabetes and bowel ischaemia were over‐represented in patients with an AKI, otherwise there was no significant difference between the two groups. Patients with an AKI were significantly more likely to die, to require an unplanned ICU admission, and less likely to return to their original residence. Overall, the expert panel agreed that the development of an AKI was foreseeable and mitigable.

Conclusion: Our patients presented with diagnoses that often did not require surgical intervention but not infrequently experienced medical complications. These patients may benefit from a shared model of care and AKI could be a useful indicator to measure the efficiency of this service.