SP9.4 - Post-operative outcomes after emergency stoma surgery in frail older adults in the West of Scotland

Abstract Aim An emergency laparotomy (EmLap) is a common surgical procedure in the United Kingdom for older adults aged 65 and above. A significant proportion of the EmLap population is frail (20%), which is associated with increased post-operative mortality and care requirements. Stoma formation is often preferred over a bowel anastomosis in this frail population, as an anastomosis is often considered too high risk. However, there is a lack of research describing post-operative outcomes after emergency stoma surgery for this frail older adult population. Methods A retrospective review of a prospectively maintained EmLap database (ELLSA) across 3 hospitals was performed between December 2019 to 2022. Older adults undergoing emergency stoma formation per NELA criteria were included. All patients had 1-year minimum follow-up. A Rockwood frailty score of more than 4 was considered ‘frail’. Results 234 older adults were identified (Median age: 74 years (Range: 65 to 91 years); 23% frail; Median follow-up: 27 months). 30% of frail patients died within 30-days, compared with 19% of non-frail patients (p=0.04). Of the frail survivors, only 47% were managing their stoma independently (compared with 76% of those without frailty, p<0.001) and 20% were in new long-term care (compared with 6% of those without frailty, p=0.002). Conclusion Frail older adults experience unfavourable outcomes after emergency stoma surgery, indicated by higher mortality rates and a limited ability to manage their stomas independently. Therefore, in selected cases, these patients may benefit from discussion around a higher risk anastomosis rather than a stoma. This study underscores the importance of further research to identify such patients and enhance pre-operative supported decision-making processes.