Impact of a Care Pathway for Older Patients Undergoing Emergency Abdominal Surgery: A Before‐and‐After Study

In this 'before-and-after' study a care pathway designed for older patients undergoing emergency abdominal surgery had no significant impact on the composite outcome of postoperative mortality and complications. Postoperative 30-day mortality, pulmonary and gastrointestinal complications were significantly reduced, while long-term mortality remained high. Although the results should be interpreted with caution, they highlight the importance of careful preoperative evaluation. In this study, outcomes of elderly patients undergoing emergency abdominal surgery were compared before and after implementation of a care pathway for elderly patients in a moderately sized single centre. Overall it is noted that implementation of this care pathway resulted in a decision to offer palliation instead of surgery to several patients. While the primary outcome of comprehensive complication index did not differ between the before-and after groups, several secondary outcomes were improved in the after group. It should be noted however that multiple confounders could explain the difference, including selection bias of a more robust population offered surgery. The one-and three year mortality of both groups was very high, stressing the importance of a careful and critical assessment of preoperative comorbidity and frailty, as well as the importance of ensuring that the treatment offered aligns with the overall goals of care for the individual patient.