ABSTRACT
BACKGROUND: For many patients with locally advanced renal cancer, management is surgery followed by surveillance imaging for several years. There is no concrete data regarding specialist nurse follow-up for patients after they have had surgery. AIMS: The authors' aim was to assess patient satisfaction with specialist nurse follow-up for patients with renal cancer who have undergone surgery. METHODS: A questionnaire was used to measure patient satisfaction of the specialist nurse consultation. There were 100 patients invited who had been followed up in the nurse-led clinic between January 2020 and May 2021. These patients were given a phone call to complete the questionnaire. FINDINGS: The audit revealed that in terms of general satisfaction, 97.1% of patients felt totally satisfied with their visit/consultation at the specialist nurse clinic. Furthermore, 94.2% of patients felt that they had good continuity of care with specialist nurse follow-up. CONCLUSION: Nurse-led follow-up was found to have high levels of patient satisfaction.
Subject(s)
Kidney Neoplasms , Nurses , Humans , Patient Satisfaction , Follow-Up Studies , Nurse's Role , Kidney Neoplasms/surgeryABSTRACT
INTRODUCTION: Although high rates of in-hospital mortality have been described in older patients undergoing emergency laparotomy (EL), less is known about longer-term outcomes in this population. We describe factors present at the time of hospital admission that influence 12-month survival in older patients. METHODS: Observational study of patients aged 75 years and over, who underwent EL at our hospital between 8th September 2014 and 30th March 2017. RESULTS: 113 patients were included. Average age was 81.9 ± 4.7 years, female predominance (60/113), 3 (2.6%) lived in a care home, 103 (91.2%) and 79 (69.1%) were independent of personal and instrumental activities of daily living (ADLs) and 8 (7.1%) had cognitive impairment. Median length of stay was 16 days ± 29.9 (0-269); in-hospital mortality 22.1% (25/113), post-operative 30-day, 90-day and 12-month mortality rates 19.5% (22), 24.8% (28) and 38.9% (44). 30-day and 12-month readmission rates 5.7% (5/88) and 40.9% (36). 12-month readmission was higher in frail patients, using the Clinical Frailty Scale (CFS) score (64% 5-8 vs 31.7% 1-4, p = 0.006). Dependency for personal ADLs (6/10 (60%) dependent vs. 38/103 (36.8%) independent, p = 0.119) and cognitive impairment (5/8 (62.5%) impaired vs. 39/105 (37.1%) no impairment, p = 0.116) showed a trend towards higher 12-month mortality. On multivariate analysis, 12-month mortality was strongly associated with CFS 5-9 (HR 5.0403 (95% CI 1.719-16.982) and ASA classes III-V (HR 2.704 95% CI 1.032-7.081). CONCLUSION: Frailty and high ASA class predict increased mortality at 12 months after emergency laparotomy. We advocate early engagement of multi-professional teams experienced in perioperative care of older patients.
