Changes in social care after major emergency general surgery procedures

Background: Emergency general surgery (EGS) is a major part of the provision of healthcare, and patients undergoing EGS are at elevated risk of morbidity and mortality. This study aimed to determine factors contributing to patients losing their independence and being discharged to residential and nursing homes having previously lived in their own residences. Methods: Our local data uploaded to the National Emergency Laparotomy Audit (NELA) (2014-2022) were analyzed. This national database encompasses all major EGS cases undertaken in the United Kingdom. The variables considered were patient demographics, American Society of Anesthesiologists score, admission and discharge dates, presenting pathology, operation type, and discharge destination. Comparative analyses segmented patients based on postdischarge EGS destinations. Multivariable logistic regression identified factors linked to residential/nursing home placement after discharge. Significance was set at P < .05. Results: Data from all patients in the NELA database (n = 1611) were analyzed. Approximately 1 in 10 patients older than 70 years never returned home. Patients requiring additional support were on average 8.6 years older (P = .008). At older than 80 years, the need for extra social support increased substantially with each increasing year in age, and those older than 85 years were more than twice as likely to require extra support than 80 -year -olds (P < .001). Patients who died were 11.4 years older than those discharged without additional support (P < .001). Conclusion: A significant proportion of patients, particularly the elderly, do not return to their usual place of residence and require a higher level of care postemergency surgery. These important social factors need to be considered before operating given that they may have significant quality of life and economic implications. (c) 2024 Society for Surgery of the Alimentary Tract. Published by Elsevier Inc. All rights reserved.