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Background: Australia's ageing population is challenging for surgical units and there is a paucity of evidence for geriatric co‐management in acute general surgery. We aimed to assess if initiating a Geriatric Medicine in‐reach service improved outcomes for older adults in our Acute Surgical Unit (ASU). Methods: The Older Adult Surgical Inpatient Service (OASIS) was integrated into ASU in 2021. We retrospectively reviewed all patients over age 65 admitted to ASU over a 12‐month period before and after service integration with a length of stay (LOS) greater than 24 h. There was no subsequent truncation or selection. Primary outcomes were 30‐day mortality, LOS, and 28‐day readmissions. Secondary outcomes were discharge disposition, in‐hospital mortality, and hospital‐acquired complications (HACs). Results: 1339 consecutive patients were included in each group, with no differences in baseline characteristics. There was a significant decrease in 28‐day readmissions from 20.2% to 16.0% (P < 0.05), greatest in patients undergoing non‐EL operative procedures (21.9% pre‐OASIS vs. 12.6% post‐OASIS; P < 0.05). Trends towards reduced 30‐day mortality (7.17% vs. 5.90%; P = 0.211), in‐hospital mortality (3.88% vs. 2.91%; P = 0.201), permanent care placement (7.77% vs. 7.09%; P = 0.843) and HACs (8.14% vs. 7.62%; P = 0.667) were seen, although statistical significance was not demonstrated. LOS remained unchanged at 4 days (P = 0.653). Conclusion: The addition of a geriatric in‐reach service to a tertiary ASU led to a significant reduction in 28‐day readmissions. Downtrends were seen in mortality, permanent care placement, and HAC rates, while LOS remained unchanged. We aimed to assess if initiating a geriatric medicine in‐reach service (OASIS) improved outcomes for older adults in a tertiary acute surgical unit (ASU). We retrospectively reviewed all patients over age 65 admitted to ASU over a 12‐month‐period before and after service integration with primary outcomes being 30‐day mortality, length of stay (LOS), and 28‐day hospital readmissions and secondary outcomes being discharge disposition, in‐hospital mortality, and hospital‐acquired complications (HACs). The addition of OASIS led to a significant reduction in 28‐day readmissions, with downtrends seen in mortality and HAC rates, and an unchanged LOS. [ABSTRACT FROM AUTHOR]

Aim: To establish if the NELA risk calculator underestimates mortality risk in older adults undergoing laparotomy for mesenteric or colonic ischaemia. Methods: A retrospective search of the operative database was performed for all patients over age 65 years who underwent laparotomy across two tertiary centres over a 3-year period. Cases of mesenteric or colonic ischaemia were identified from the operative records. Cases where ischaemia occurred secondarily to a primary obstructive or other pathology were excluded. Cases where a NELA score was not documented preoperatively were excluded. We then compared the NELA scores to the observed 30-day mortality rate. Secondary outcomes were hospital length of stay and intensive care unit length of stay. Results: Sixty cases were included in our analysis. There were 27 cases of colonic ischaemia and 33 cases of mesenteric ischaemia (mesenteric ischaemia group included five cases of distal small-bowel and colonic ischaemia). The overall mean NELA score was 21.9%, while the actual 30-day mortality was 43.3% (p=0.0094). Mean NELA score for mesenteric ischaemia cases only was 20.6% with an actual mortality rate of 45.5%. Mean NELA score for the colonic ischaemia cases was 23.5% with an actual mortality rate of 40.7%. The median time from operation to mortality was 8 days. Mean age was 77 years. Length of stay for survivors was a mean 27 days with intensive care unit length of stay of 9.3 days. Conclusion: The NELA risk score for mortality post–emergency laparotomy underestimates mortality risk by a factor of two in older adults where the primary pathology is mesenteric or colonic ischaemia. [ABSTRACT FROM AUTHOR]

We present a case of extensive stage small cell lung cancer presenting as perforated appendicitis secondary to an appendiceal metastasis. This is a rare presentation with only six reported cases in the literature. Surgeons must be aware of unusual causes for perforated appendicitis as in our case the prognosis can be dire. A 60-year-old man presented with an acute abdomen and septic shock. Urgent laparotomy and a subtotal colectomy were performed. Further imaging suggested the malignancy was secondary to a primary lung cancer. Histopathology demonstrated a ruptured small cell neuroendocrine carcinoma in the appendix with thyroid transcription factor 1 positive immunohistochemistry. Unfortunately, the patient deteriorated due to respiratory compromise and was palliated day six postoperatively. Surgeons should consider a broad differential diagnosis for the cause of acute perforated appendicitis as this can rarely be due to a secondary metastatic deposit from a widespread malignant process. [ABSTRACT FROM AUTHOR]