L. M. Warkentin1, T. F. Ali1, S. Gazala1, A. S. Wagg2, R. S. Padwal3, R. G. Khadaroo1 2University Of Alberta,Division Of Geriatric Medicine,Edmonton, ALBERTA, Canada 3University Of Alberta,Division Of General Internal Medicine,Edmonton, ALBERTA, Canada 1University Of Alberta,Department Of Surgery,Edmonton, ALBERTA, Canada
Introduction: Emergency surgery is increasingly common in older patients (≥ 65 years old). Prior studies have shown that post-operative complications, in-hospital mortality, and an increased requirement for post-discharge care are more common in older patients. Patient-reported outcomes, including assessments of cognitive status, functional capacity and health-related quality of life (HRQL), are understudied. We conducted a six-month prospective cohort study in patients ≥ 65 years admitted to a specialized acute care and surgical emergency service at a single, publicly-funded, tertiary care center in Edmonton, Canada.
Methods: Participants, or their surrogates, completed the Abbreviated Mental Test Score-4 (AMTS-4) to measure cognitive status, Barthel Index to assess functional status, Vulnerable Elders Survey (VES-13) to examine risk of health deterioration, and EuroQol-5 Dimensional Scale (EQ-5D) for HRQL within 24 hours of admission to hospital and 6 months post-discharge. Paired t-tests or McNemar’s tests were used to assess differences in instrument scores between baseline and 6 months.
Results: One hundred fifty-five consecutive patients (including 16 surrogates) were enrolled. Sixteen (10%) patients died within 6 months of discharge and 116 (75%, including 18 surrogates) completed a follow-up assessment 6 months post-discharge. Fifty-two percent of patients were female and mean age was 77 years (SD 8). One hundred and two (66%) patients underwent surgery and 53 (34%) managed non-surgically. Cognitive status improved substantially over 6 months, 72 (52%) patients had AMTS scores showing cognitive impairment at baseline and 4 (4%) patients at 6 months (p < 0.001). The mean (SD) Barthel Index score was 91.2 ± 14.1 at baseline and 92.8 ± 12.9 at 6 months (p > 0.05). Forty-seven (31%) patients had VES-13 scores indicating risk of health deterioration at baseline, and 33 (28%) patients at 6 months (p > 0.05). Mean (SD) EQ-Index score at baseline was 0.76 ± 0.24, and 0.86 ± 0.19 at 6 months (p > 0.05). Mean EQ-VAS score was 68.4 ± 20.3 at baseline and 72.0 ± 15.1 at 6 months (p > 0.05). Of the 116 patients that completed follow up, 17 patients (15%) required post-discharge escalation of care.
Conclusion: Elderly patients admitted to an acute care surgery service maintained functional capacity and improved quality of life 6-months post-discharge. Initially low cognitive scores improved substantially in most patients, suggesting that the acute illness led to reversible cognitive impairment. Our data suggest that the acute care surgery model leads to very low rates of cognitive impairment with good functional and HRQL outcomes in elderly patients presenting with emergent surgical illness.
