Posters for 2025 POPS (Perioperative Care of Older People Undergoing Surgery) Meeting

Background Shared decision making (SDM) is supported by NICE, the Royal College of Surgeons, General Medical Council and protected through legislation. Evidence continues to be produced to support the use and implementation of SDM prior to elective surgery, however, little work appears to have been done in the emergency surgical setting. Decision making prior to emergency surgery can be complex, especially for older patients with increasing frailty whose risks from surgical intervention are higher than the general population. SDM in this context therefore has substantial importance. This is a

Introduction Increasing numbers of older people are undergoing major arterial surgery and major lower limb amputations for peripheral vascular disease (PVD). Osteoporosis and PVD share several common risk factors. In 2024, the National Osteoporosis Guideline Group (NOGG) updated their recommendations to include lower limb amputation as an additional clinical risk factor that should prompt proactive bone health assessment in this group. Perioperative Comprehensive Geriatric Assessment (CGA) provides a context where this can occur. Method Data were collected prospectively as part of a service

Background Cardiovascular complications are one of the most common causes of morbidity and mortality perioperatively during non-cardiac surgery. This risk is significantly increased in those ≥65 and those who are frail. NICE and ESC both recommend that all patients ≥65 have a pre-operative ECG to assess each patient's risk of perioperative cardiovascular complications before any intermediate or high-risk surgery. This study aims to assess the risk of perioperative cardiovascular complications in those ≥65 with abnormal ECGs. Methods We analysed data from patients attending our combined

Aim This study aimed to assess management pathways and outcomes in sigmoid volvulus (SV). Methods A retrospective review was performed on patients first admitted with SV between 2019 and 2023 within a tertiary-level colorectal service. Demographic, management, and outcome data, including frailty, ASA (American Society of Anaesthesiologists), and National Emergency Laparotomy Audit (NELA) score, were collected. Comparative statistics were used to compare baseline demographics between those operated on and those not and to identify factors associated with survival. Results A total of 72 patients

Introduction: The Centre for Perioperative Care Guidelines for People Living with Frailty emphasises the need for routine frailty assessment and subsequent Comprehensive Geriatric Assessment (CGA) in older adults within the emergency surgical setting. Medication review and optimisation is an integral part of the CGA. The Scottish Government’s Polypharmacy Guidance provides a 7 steps structure for patient-centred medication reviews. Utilising this structure, our aim was to establish a standardised method for documentation and recording of medication reviews as part of CGAs undertaken by our

Introduction: Inpatient falls are common and serious issue in healthcare, often leading to complications like traumatic brain injuries. Timely and appropriate evaluation using Computed Tomography (CT) scan of the head is crucial for diagnosing and managing those injuries. Clinical guidelines, such as those established by the National Institute for Health and Care and Excellence (NICE) and Royal College of Radiology (RCR) outline when CT head should be performed after a fall to ensure timely intervention and efficient use of resources. However, adherence to this guideline varies, sometimes

Introduction The National Hip Fracture Database (NHFD) 2023 report recommended a care bundle for patients leaving theatre recovery to include anaesthetists’ postoperative instructions regarding blood pressure, fluid management, transfusion and postoperative pain to improve outcomes. This audit evaluates our effectiveness in adhering to these recommendations.​ Methods We retrospectively audited the case notes of 51 hip fracture patients undergoing surgery between June and September 2024 in our trauma centre. Results 76.5% of patients were >80 years, 27.5% were ASA grade 4. One of the 51

Intro: Postoperative delirium (POD) affects 15-50% of older cardiac surgery patients, yet its long-term functional consequences remain poorly characterised. This study examines the association between POD and 5-year trajectories of disability using prospectively collected Barthel Index data. Methods: We analysed 135 patients aged ≥60 undergoing elective CABG±valvular surgery at a UK tertiary centre (2017-2023). POD was identified through daily Postoperative Morbidity Survey (POMS) assessments. Functional status was measured via Barthel Index (0-20) preoperatively and at discharge and at 6

Introduction Diabetes is prevalent (15%) in patients undergoing hip fracture surgery, with inadequate perioperative management linked to poor outcomes. National guidelines recommend surgical prioritisation, medication management, strict glycaemic and electrolyte monitoring, yet adherence remains suboptimal. This audit assessed compliance with the Centre for Peri-Operative Care standards at Ealing Hospital. Method A six-month retrospective audit (Aug 2024 – Jan 2025) reviewed the perioperative care of 26 diabetic patients (28% of 94 total hip fracture cases). Data were collected using online

Introduction: The increasing prevalence of osteoporosis, rising numbers of total hip replacements, and longer life expectancy have contributed to a growing incidence of periprosthetic femoral fractures (PPFFs), particularly in elderly, frail, and comorbid populations. In the UK, the Best Practice Tariff (BPT), introduced in 2010, aimed to improve outcomes in neck of femur (NOF) fractures through timely surgery and orthogeriatric care. For NOF fractures, strong, robust evidence links early surgery with better outcomes. Since 2020, the National Hip Fracture Database (NHFD) has included PPFFs

Introduction A growing evidence base demonstrates that perioperative frailty screening is essential to improve post-operative outcomes, yet it is underutilised in many hospitals. People living with frailty undergoing surgery can be complex and multimorbid with a high risk of complications, and comprehensive geriatric assessment in such cases is invaluable. This study quantifies the impact of initiating a POPS service in Swansea Bay University Health Board, with outcome data over a two-year follow-up period. Method In 2022, a quality improvement project to establish a POPS team was undertaken

Introduction: Enhanced Recovery After Surgery (ERAS) protocols have significantly improved outcomes in elective surgery, but their application in emergency settings—particularly for elderly patients—remains limited. Although ERAS guidelines for emergency laparotomy exist, uptake in clinical practice is inconsistent. Data from the National Emergency Laparotomy Audit (NELA) show that patients aged ≥65 experience significantly worse outcomes than younger cohorts, with a 30-day mortality of 15.3% compared to 4.9%, and longer hospital stays (15.2 vs. 11.3 days)1. Our aim was to develop a modified

There is strong evidence in the medical literature that a fracture following a fall, and especially a neck of femur fracture, is one of the most serious events that can happen in an older person’s lifetime. These fractures have been associated with increased morbidity, loss of independence, a high rate of institutionalization, and mortality. Rates of mortality after a year from femoral fractures have been proven to be three to four times higher than the expected in the general population, ranging between 15% to 36%. This emphasizes the importance of developing well-organized care pathways for

Introduction: As neurosurgical procedures are increasingly performed on older patients, there is a growing need to incorporate geriatric care to optimise clinical outcomes. In response, the neurosurgical and geriatric teams at our institution collaborated and launched an in-reach service for elderly patients on neurosurgical wards in January 2025. This project aimed to identify staff perceptions around how the new service could benefit neurosurgical patients and identify areas for improvement. Methods: This qualitative study involved interviewing 15 colleagues across the Neurosurgical multi

Introduction Neck of femur (NOF) fractures account for over 60,000 cases in England and are often elderly, with multiple co-morbidities. Post-operative delirium is a frequent complication seen in these patients. With an increasingly frail population, the rates of NOF fractures and associated delirium are projected to increase. Current guidelines state that professionals should actively assess for cognitive impairment upon initial presentation. We aimed to evaluate the compliance of utilising the 4AT tool in post-operative NOF patients, and correlation between post-operative delirium with

Background: Involvement of Geriatricians in peri-operative assessment acknowledges the altered physiology of frail patients and helps to evaluate realistic outcomes as part of patient-centred shared decision making. This is with the aim of addressing modifiable risk factors, preventing complications, preparing for a realistic recovery and ensuring that treatment options are aligned to what is important to the patient. There is data suggesting improved survival following geriatric peri-operative assessment but little analysis from the patient’s perspective; their thoughts about the shared

Introduction With a growing number of older adults undergoing cardiac surgery, there is increasing emphasis on recovery outcomes beyond morbidity and survival. Many patients prioritise cognition and independence, yet these domains are not routinely assessed. Frailty, multimorbidity and cognitive vulnerability are common in this population, increasing risk of poor longer-term outcomes. However, longitudinal evidence describing cognitive and functional trajectories after surgery remains limited. We characterised cognitive and functional trajectories of older cardiac surgical patients over 5

Introduction This quality improvement (QI) project aimed to enhance patient experience and safety by reducing fluid fasting times by embedding the recently introduced "Sip til Send" policy in our acute orthopaedic trauma unit. Our concern was that older patients with hip fractures, who are often living with frailty and at high risk of complications, were being kept Nil by Mouth (NBM) for extended periods before operative intervention The "Sip Til Send" policy supports eligible patients in consuming clear fluids (170 mL/hour) until transfer to theatre with a reduction in distress, thirst

Background For patients aged ≥65 awaiting elective hip or knee surgery to be appropriately referred to a Perioperative Care of the Older People Undergoing Surgery (POPS) clinic, an accurate Clinical Frailty Scale (CFS) score is essential. Following the launch of a trial POPS clinic at Royal Surrey Foundation Trust, we compared referral letter CFS scores with those assessed by frailty-trained professionals. 75% of referrals lacked a CFS score, 12.5% differed, and 12.5% matched. To improve scoring accuracy and support appropriate referrals, we developed a CFS Scoring Toolkit, including a patient

Background: TEP’s are a tool used in acute hospital admission to guide appropriate care in the event of deterioration. TEP’s, a gold standard in the SIGN 167 guideline, help ensure that care aligns with the patients’ and families’ wishes. Though all patients should ideally have one on admission, this can be challenging to achieve. Patients with CFS (Clinical Frailty Scale) >5, NEWS >5, DNACPR, or progressive conditions, however, are at higher risk of deterioration and ensuring a valid TEP is in place is vital. Aim: To increase the number of patients in the Orthopaedic ward with a valid TEP in