815 FRAILTY AND MULTIMORBIDITY ARE ASSOCIATED WITH LONGER LENGTH OF STAY IN OLDER UROLOGY PATIENTS

Introduction

Frailty and geriatric syndromes are becoming common place in surgical services. In general surgery, frailty has been shown to be associated with longer length of hospital stay. The effect of frailty on outcomes in Urology patients is not well described. We aimed to evaluate the effect of frailty and multimorbidity on length of stay in older patients admitted for emergency Urology care.

Methods

Adults aged 65 years and older admitted as an emergency to the Urology service during 4 months of 2020/21 were included. The primary outcome was time to discharge; analyses were adjusted for Clinical Frailty Scale (CFS), Charlson Comorbidity Index (CCI), age, gender, and surgical procedure (yes/no).

Results

142 patients were included, of these 60 (42.3%) were living with frailty (CFS ≥5), 32 (22.5%) were multimorbid and 59 (41.5%) underwent a surgical procedure. Longer length of stay was associated with frailty (adjusted-HR 0.560; 95% CI 0.376–0.835; p 0.004) and multimorbidity (adjusted-HR 0.556; 95% CI 0.367–0.842; p 0.006).

Conclusion

In this single-centre study we found frailty and multimorbidity to be associated with longer length of stay in patients admitted for emergency Urology care. Geriatric perioperative care interventions in other surgical specialties have been shown to reduce length of stay, the effect of such services within urology has yet to be established. Identification of frail and multimorbid patients could help to develop targeted strategies to improve outcomes, and ultimately reduce hospital stay.

805 UPPER LIMB FRACTURE PATHWAYS IN FRAILTY ENABLE EARLIER RETURN TO FUNCTION WITH ASSOCIATED REDUCED LENGTH OF HOSPITAL STAY

Introduction

Upper limb fractures are the second most common fracture requiring admission to hospital after hip fracture [Jennison, 2019]. At 1-year 20.5% have died, compared to 29.5% in hip fracture [Wiedl, 2021]. Local Problems: At North Bristol Trust most patients with upper limb fractures and a Clinical Frailty Score ≥ 5 are managed non-operatively on medical wards. Local service evaluation identified a long length of stay of 23 days. Case note review revealed: • Delayed transfers of care (DTOCs) had been managed non-weight bearing in slings for 4–6 weeks. • Non-weight bearing status resulted in DTOC due to declined access to social care and rehabilitation due to perceived health needs. • A high rate of hospital-acquired complications and failure to rehabilitate. • Breakdown in interdisciplinary communication and ownership across the pathway.

Methods

A multidisciplinary QI project was commenced. Using local data through business analytics, clinician and patient feedback, a new Trust guideline was developed for older people with frailty and upper limb fractures. Data collected determined average length of stay before and after implementation of the service change. A standard process control chart was created monitoring the effect of the changes in the pathway. The multidisciplinary team met regularly to make alterations during implementation. The resulting intervention included: • Removal of functional restrictions; allow free use of limb as comfort permits. • Simplified slings and minimised light weight casts. • Proactive integration of orthopaedic plan into CGA documentation. • Proactive interdisciplinary communication across pathways. • Patient information leaflets.

Results

Pre-intervention average length of stay was 23 days. Post-intervention was 14 days.

Conclusion

Proactive, structured management of upper limb fractures in people with frailty is associated with significant reduction in acute hospital length of stay. Next steps include a business case for a frailty trauma specialist therapist embedded into medicine.

812 GERIATRIC PERIOPERATIVE CARE IS ASSOCIATED WITH REDUCED LENGTH OF STAY IN UROLOGY PATIENTS

Introduction

Comprehensive Geriatric Assessment (CGA) is associated with reduced length of stay and perioperative complications in older orthopaedic, gastrointestinal and vascular surgical patients [1,2,3]. Limited published data from a single UK centre [4] reports reproducing these outcomes in a urological setting. It is unclear whether these outcomes can be repeated in other urological centres.

Method

We piloted a Geriatric Perioperative Care service delivering CGA to older emergency urology patients admitted to within a tertiary centre. The aim of the service was to reduce length of hospital stay (LOS). We evaluated it using quality improvement methodology. Patients for review were identified using age ≥ 65 and the Clinical Frailty Scale. Patients that were transferred to another hospital team prior to discharge were excluded.

Results

101 patients were included: 35 in the pre-intervention group and 66 in the post-intervention group. Mean LOS in the pre-intervention group was 7 days. In the post-intervention group, mean LOS was reduced to 3.5 days, 6 days and 5.5 days in the first, second and third months respectively.

Conclusion

We found that perioperative geriatric care was associated with reduced length of stay in older urology patients. These data would support the need for larger and/or multicentre studies to evaluate the relationship between geriatric intervention in urological inpatients and length of hospital stay. References: on request due to word count.