{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T06:02:43Z","timestamp":1790488963097,"version":"4.1.0"},"reference-count":35,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2026,1,9]],"date-time":"2026-01-09T00:00:00Z","timestamp":1767916800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,9]],"date-time":"2026-01-09T00:00:00Z","timestamp":1767916800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100004257","name":"Helse Vest","doi-asserted-by":"publisher","award":["F\u201011005"],"award-info":[{"award-number":["F\u201011005"]}],"id":[{"id":"10.13039\/501100004257","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Anaesthesiol Scand"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Older patients undergoing emergency abdominal surgery face high risks of mortality and complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Investigate whether a care pathway designed for older patients improves surgical outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This single\u2010centre study investigated the effect of a care pathway for older patients undergoing emergency abdominal surgery, including preoperative frailty assessment, optimised perioperative care, and structured decision\u2010making for severely frail patients. Following implementation of the pathway, patients aged \u2265\u200975\u2009years were prospectively enrolled in the \u2018after\u2019 cohort (1 January 2020\u201316 April 2021) and compared with a historical \u2018before\u2019 cohort of patients (1 January 2016\u201331 December 2017). The primary outcome was the Comprehensive Complication Index (\n                      <jats:styled-content style=\"fixed-case\">CCI<\/jats:styled-content>\n                      ), a composite measure encompassing 30\u2010day mortality and postoperative complications. Secondary outcomes included 30\u2010day postoperative mortality, the number of palliative patients, mortality at 1 and 3\u2009years and postoperative complications.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 154 patients in the \u2018after\u2019 cohort (median age 82\u2009years [\n                      <jats:styled-content style=\"fixed-case\">Q1<\/jats:styled-content>\n                      \u2013\n                      <jats:styled-content style=\"fixed-case\">Q3<\/jats:styled-content>\n                      : 78\u201386], 54% women, 53% frail), the primary outcome did not differ significantly from that of the 170 patients in the \u2018before\u2019 cohort (\n                      <jats:styled-content style=\"fixed-case\">CCI<\/jats:styled-content>\n                      mean [95%\n                      <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\n                      ]: 44 [39\u201348] vs. 50 [46\u201355];\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.15). Postoperative 30\u2010day mortality was significantly reduced (22% vs. 13%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.04). During the intervention, severely frail patients triaged to palliation (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200912) were excluded from the study and received palliative care. High postoperative mortality was observed at 1 (31%) and 3\u2009years (49%). Pulmonary (44% vs. 69%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) and gastrointestinal complications (39% vs. 52%;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.02) were significantly reduced.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In this \u2018before\u2010and\u2010after\u2019 study a care pathway designed for older patients undergoing emergency abdominal surgery had no significant impact on the composite outcome of postoperative mortality and complications. Postoperative 30\u2010day mortality, pulmonary and gastrointestinal complications were significantly reduced, while long\u2010term mortality remained high. Although the results should be interpreted with caution, they highlight the importance of careful preoperative evaluation.<\/jats:p>\n                    <jats:p>In this study, outcomes of elderly patients undergoing emergency abdominal surgery were compared before and after implementation of a care pathway for elderly patients in a moderately sized single centre. Overall it is noted that implementation of this care pathway resulted in a decision to offer palliation instead of surgery to several patients. While the primary outcome of comprehensive complication index did not differ between the before\u2010and after groups, several secondary outcomes were improved in the after group. It should be noted however that multiple confounders could explain the difference, including selection bias of a more robust population offered surgery. The one\u2010and three year mortality of both groups was very high, stressing the importance of a careful and critical assessment of preoperative comorbidity and frailty, as well as the importance of ensuring that the treatment offered aligns with the overall goals of care for the individual patient.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/aas.70182","type":"journal-article","created":{"date-parts":[[2026,1,10]],"date-time":"2026-01-10T07:25:18Z","timestamp":1768029918000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Impact of a Care Pathway for Older Patients Undergoing Emergency Abdominal Surgery: A Before\u2010and\u2010After Study"],"prefix":"10.1111","volume":"70","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3131-8914","authenticated-orcid":false,"given":"Elin Kismul","family":"Aakre","sequence":"first","affiliation":[{"name":"Department of Anaesthesia and Intensive Care Haukeland 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