3670 The role of comprehensive geriatric assessment and shared decision making in general surgical inpatients

Abstract Introduction Our perioperative service for older people undergoing surgery (POPS) commenced inpatient reviews in September 2024. Method Patients being considered for laparotomy aged 80 and over were prioritised as part of the national emergency laparotomy audit (NELA) recommendations. Other patients reviewed were multi-morbid and frail patients with other pathologies, aged between 65–80. All patients reviewed had a comprehensive geriatric assessment (CGA) and shared decision making (SDM) as required. Results In 3 months, 115 patients were seen. Median age 83, median clinical frailty score 4 (mild frailty: range 2–8). 22% had surgery, LOS range 2–96 days (2 longest were admitted pre-POPS), median LOS 7. 7% were readmitted within 30 days. 32% already had a DNA CPR/ReSPECT in place, POPS discussed treatment escalation with an additional 25% patients. End of life discussions and pathways instigated by POPS in 8 patients. SDM discussions regarding surgical treatment plans were undertaken in 11 patients. 18% did not need intervention, 55% chose not to have treatment and 27% chose to proceed with surgery after SDM. 53% of patients had medical complications, to which POPS gave input. For the laparotomy group aged 80 and over, 3 months pre and post POPS LOS analysis was undertaken. There was a reduction in LOS from 17 to 14.8 days. There were 4 patients readmitted within 30 days pre-POPS and none in the post-POPS group. Patient and colleague feedback were obtained. Patient feedback was adapted from experience-based design. Feedback on the POPS intervention was overwhelmingly positive. Conclusion The POPS intervention was well received by patients and colleagues. There was a trend in reduction in LOS (by 2.2 days) and readmission rates in the older laparotomy group. Quality of care was improved for all seen by virtue of medical input, SDM and escalation discussions.