SRS246 - Addressing the double burden: elevated mortality and missed tariff opportunities in octogenarians undergoing emergency laparotomy—a case for geriatric surgical liaison services in NHS hospitals

Abstract Emergency laparotomies in octogenarians represent a growing national challenge, combining high clinical risk with substantial financial loss to NHS hospitals. A three-year retrospective review at George Eliot Hospital analysed 370 emergency laparotomies, including 62 patients aged ≥80 years. The mean age was 84 years; 56.5% underwent bowel resection and 16.1% required stoma formation. The 30-day mortality rate was 21%, considerably exceeding national benchmarks. None of these patients received perioperative geriatric input. A concurrent audit assessing compliance with the 2023 National Emergency Laparotomy Audit (NELA) Best Practice Tariff (BPT) showed 0% compliance for elderly care review in patients ≥80 years, translating to an estimated annual revenue loss of £119 978–£152 008. This double burden of excess mortality and missed BPT income highlights a systemic gap in emergency surgical pathways. Evidence from NELA demonstrates that integrating geriatricians into perioperative care improves survival, optimises recovery, and enhances discharge planning. We propose a Geriatric Surgical Liaison Service embedded within all NHS emergency surgical units, featuring twice-weekly consultant geriatrician ward rounds, frailty scoring at admission, and joint surgical-geriatric care planning. Implementing this model across NHS hospitals would address both patient safety and financial sustainability, aligning clinical excellence with economic responsibility. The findings present a compelling case for national adoption of geriatric surgical liaison services—transforming outcomes for frail elderly patients while supporting Trusts to achieve Best Practice Tariff compliance and reinvest savings into frontline care. Keywords: Emergency Laparotomy, Octogenarians, Frailty, Best Practice Tariff, Mortality, NELA, Perioperative Care