LAUSR

Need for a geriatrician in the peri operative care of older surgical patients is evident by the NCEPOD reports in 2010 and 2011. Funding for Consultant Geriatrician led surgical liaison service for RBH was approved in 2014.We present a comparative review of the service during 2019/2020. A retrospective audit of elective and emergency surgical patients over 65 years of age from January to March 2019 and June to September 2020 was done. Geriatrician input was provided on weekdays by Less than full time (80%) equivalent Consultant, 1 full time equivalent physician associate and a Gerontology Registrar on pro rota basis. We reviewed 76 patients in 2019 (Emergency 74/76 = 95% Vs Elective 2/76 = 3%) and 161patients in 2020 (Emergency134/161 = 83% Vs Elecetive27/161 = 17%). Majority of emergency presentations were small bowel obstruction, acute cholecystitis, and pancreatitis while laparoscopic right hemi colectomy was the commonest elective surgical admission. The average age of patients was 72 years (2019) and 79 years (2020). Length of stay up to 5 days reduced from 75% (51/76) in 2019 to 43% (70/161) in 2020. The overall length of stay reduced from 12 days to 8.5 days in 2019 and 2020, respectively 30 days readmission rate increased from 21% (16/76) in 2019 to 25.5% (41/161) in 2020. 75% (2019) and 96% (2020) of patients were discharged back to their usual residence and death rates reduced from 14% to 1% between the 2 audits. There is an increase in patient number, age, and complexity. Number of elective surgical admissions after the 1st Covid wave has risen. Even with less than full time Consultant Geriatrician cover the service has helped to reduce the overall length of hospital, mortality rate and added to cost saving. There is need for senior cover for service to work efficiently and to meet its ever-increasing demand.