One-year outcomes of patients who do not proceed with surgery following comprehensive review in a tertiary centre.

5116

Ff Evans 1; M Coakley 2; N Humphry 3

1. Department of Medical Education; Cardiff and Vale University Health Board; 2. Department of Anaesthetics; Cardiff and Vale University Health Board; 3. Department of General Surgery; Cardiff and Vale University Health Board.

Clinical Quality

CQ - Patient Centredness

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Abstract

Introduction: 

The Perioperative care of Older People undergoing Surgery (POPS) team supports optimisation and shared decision-making for older patients living with frailty who are being considered for surgery. Following this comprehensive assessment a proportion of patients (~14%) do not proceed with the planned surgery, but no standardised follow up process is in place. This retrospective study assessed 12-month outcomes for this cohort.

Method: 

Patients seen by POPS between September 2022 and June 2025 who did not proceed with proposed surgery were selected from the POPS database. Data were collected from digital health records via Welsh Clinical Portal to include patient demographics, planned procedure, Clinical Frailty Scale (CFS), Charlson Comorbidity Index (CCI), Malnutrition Universal Screening Tool (MUST) score and presence of a dementia diagnosis. The primary outcome measure was 12‑month mortality. Secondary outcome measures were secondary care attendances within 12-months of declining surgery including associated reason, and if deceased, whether cause of death related to the index surgical pathology.

Results: 

Forty-eight patients were included in the study. Median age 81 years. Median CFS 6. 46% (n=22) were referred for surgery relating to a malignancy. 67% (n=32) had a CCI ≥6, which estimates ≤2% 10-year survival. Within 12 months of not proceeding with surgery 38% (n= 18) of patients had died and 46% (n=22) attended secondary care. The majority of secondary care attendances were unrelated to the index surgical pathology (77%, n=17). Of those deceased 28% of deaths were attributed to the index surgical pathology, 39% were unrelated and cause of death unknown for 33%.

Conclusion: 

Older adults living with frailty who decline to proceed with surgery are at high risk of death or admission to secondary care within 12 months of their decision making. In most cases this is unrelated to the index surgical pathology.