The prevalence of multimorbidity in an older acute general surgical population
Authors: A. Tay, N. Asnan, L. Pearce, M. Stechman, K. McKarthy, S. Moug, J. Hewitt
Journal: International Journal of Surgery (2015)

s / International Journal of Surgery 23 (2015) S15eS134 S112 Aim: For the last 40 years, the Glasgow Coma Scale (GCS) has been an effective clinical tool for assessing the severity of neurological impairment and is a major component of the NICE guidelines for CT head scanning following traumatic head injury. Methods: We conducted an audit reviewing the level of knowledge of the GCS amongst clinical staff who care for head injury patients. Results: An initial questionnaire with 31 respondents found that knowledge of the GCS was poor and only 10% of doctors and nurses of all grades recorded the correct GCS when given an example scenario. Following intradepartmental teaching sessions a repeat questionnaire was circulated. 100% of nurses and doctors surveyed (n 1⁄4 31) were able to correctly identify the components of the GCS and scores for each. Ability to correctly score a clinical scenario increased to 64% in Junior Nurses, 70% in Senior Nurses, 83% in Junior Doctors and 75% in Specialist Registrars. Conclusion: Knowledge of the GCS amongst clinical staff was found to be poor. This was improved following the intervention of departmental teaching. This allows for better neurological monitoring and prognostication in head injury patients as well as more appropriate use of facilities such as CT scanning. 0293: THE PREVALENCE OF MULTIMORBIDITY IN AN OLDER ACUTE GENERAL SURGICAL POPULATION A. Tay , N. Asnan , L. Pearce , M. Stechman , K. McKarthy , S. Moug , J. Hewitt . NHS Greater Glasgow and Clyde, UK; North Bristol NHS Trust, UK; Cardiff School of Medicine, UK; University of Glasgow, UK; Greater Manchester NHS Trust, UK Aim: Multi-morbidity is defined as the presence of two or more chronic conditions and is a new and emerging concept in geriatric medicine with implications for patient outcomes. With increasing rates of surgical procedures in the elderly the prevalence of multi-morbidity in the acute general surgical population is currently unknown. Methods: In four U.K. sites comprising rural and urban populations, we studied consecutive patients aged over 65 years that were admitted as an emergency to acute general surgical units. Patients with orthopaedic, urological, neurosurgical or vascular conditions were excluded. Patients were assessed for baseline demographic data and classified as having multi-morbidity if they had a past medical history of two or more predefined chronic conditions. Results: A total of 267 patients were analysed [mean age 77 years (range 65e98); 140 (52.4%) women]. The majority [n 1⁄4 198 (74.2%)] had multimorbidity. Increasing age (p<0.001) but not sex (p1⁄40.61) predicted multimorbidity. Conclusion: In a representative UK wide population, three quarters of people aged over 65 years admitted with an acute general surgical emergency had multi-morbidity. Follow-up data will determine the influence of multi-morbidity on short and long-term patient outcomes in this cohort. 0310: IS FASTER BETTER? OPERATIVE DURATION IN EMERGENT APPENDICECTOMY R. D'cruz , E. McDermott . University College Dublin, Ireland; 2 St. Vincent's University Hospital, Ireland Aim: Emergent appendicectomy has been accepted generally as the most appropriate treatment. Till now, there has been no objective conclusion on the timing of appendicectomy. The objective of this study was to investigate the effect of operative duration of appendicectomy on outcomes such as complications and length of stay (LOS). Methods: Retrospective study of 271 patients who had undergone appendicectomy in Year 2013 was conducted. Data includes time of presentation to Emergency Department, time of operation, length of stay & complications were collected. Pearson’s ‘r’ coefficient was used to determine the effect of operative duration on LOS. Results: 182 patients had at least one form of diagnostic imaging modality performed. Pre-operative laboratory investigations were conducted in most patients. 193 out of 261 patients (73.9%) had their surgery within 24 hours of presentation. 253 patients (93.3%) had undergone laparoscopic appendicectomy. The average operating time was 63.8 mins. There was a linear correlation between the operative duration and the length of hospital stay. There was no significant difference in the incidence of complications of acute appendicitis. Conclusion: The timing of appendicectomy was associated with increased length of stay. However, operative duration did not affect the incidence of complications of acute appendicitis. 0325: CAN ROUTINELY COLLECTED CLINICAL MARKERS FORECAST THE LIKELIHOOD OF NEXT-DAY DISCHARGE FROM HOSPITAL? S. Labbouz, D. Bragg, A. El-Sharkawy. University of Nottingham, UK Aim: Bed capacity is a finite resource under mounting pressure in the NHS. Few scoring systems are available to predict patient discharge from hospital. The purpose of this study is to identify routinely collected markers capable of predicting the likelihood of next-day discharge. Methods: 169 general surgery emergency admissions were included in this prospective pilot study. The following variables were recorded for each patient: EarlyWarning Score (EWS); presence of a catheter or nasogastric (NG) tube, eating and drinking, “awaiting a scan” and “booked for theatre” status; use of antibiotics, morphine, intravenous fluids and oxygen (O2). Bivariate analysis was used to identify the variables influencing length of stay (LOS). Results: O2 supplementation was the only predictor of a LOS greater than one day (P < 0.001) but the EWS (P 1⁄4 0.005), O2 (P < 0.001) and NG tube status (P 1⁄4 0.031) influenced mean LOS. All other variables were not significantly associated with LOS. Conclusion: This study demonstrates that the selected variables do not individually predict the likelihood of next-day discharge, although O2 supplementation was consistently associated with a longer LOS. The advent of electronic observations may facilitate recording of patient information and may further determine the influence of routinely collected markers on LOS. 0372: DOES THE USE OF A STANDARDISED CLERKING PROFORMA FOR ACUTE GENERAL SURGERY ADMISSIONS IMPROVE THE QUALITY OF DOCUMENTATION: A PROSPECTIVE TWO-CYCLE AUDIT P. Singh, H. Wyatt, H. Taylor, V. Patel, D. Francis. Barnet General Hospital,