The ELF Study team at Salford Royal

New study into older laparotomy patients

Surgeons at Salford Royal are taking part in a major new study with older patients who need emergency abdominal surgery.

The study will assess the frailty of patients aged 65 or older and check whether that has an impact on their recovery after laparotomy. This type of operation is used for people with severe abdominal pain caused by such problems as bowel obstruction, bowel perforation or internal bleeding.

Salford Royal is one of 50 NHS centres taking part in the national study led by the North West Research Collaborative.

Consultant Surgeon Jonathan Epstein is the Principal Investigator for the study at Salford Royal while Surgical Trainee Lyndsay Pearce helped design the research in her role as International Lead for Education and Research in the Older Persons Surgical Outcomes Collaboration (OPSOC).

Mr Epstein said: “Because of improvements in health care and surgical technique, we now operate on higher numbers of older people than we used to. Nowadays, more than half of emergency general surgical patients are aged 65 or older and many of them will have several health conditions (known as multimorbidity) and be on many medications.

“At present we look at all patients’ medications and multimorbidity when we assess them for surgery but we think it might be more helpful with older patients to look at how frail they are.”

Miss Pearce added: “We are assessing this with a clinical frailty scale that ranges from very fit, active and energetic older people to severely frail people, who depend on others to care for them and help with daily living.

“We are looking at how that relates to the outcome of their surgery, including post-operative complications, the length of their stay in hospital, any re-admission to hospital and survival rates.”

The project aims to collect information on about 500 patients nationally over three months and it complements previous research carried out at Salford with the Ageing and Complex Medicine Team.

The Surgical department also has an active audit programme, including the Perioperative Quality Improvement Programme (PQIP) aimed at improving outcomes for patients after major surgery. It was one of the leading recruiters to another national study looking at patients with small bowel obstruction (NASBO) and is currently recruiting to two other international audits on abdominal pain and colorectal cancer surgery.

  • You can see more about the study Emergency Laparotomy and Frailty: A national multicentre study of older surgical patients undergoing emergency laparotomy (ELF) on the North West Research Collaborative website.