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All elderly emergency surgery patients should be serially assessed for multimorbidity, frailty and cognition.^1,6,7

The outcomes following emergency surgery for elderly patients (particularly patients who are either partially or wholly dependent) are considerably worse than for younger patients. Consequently, planning of care and decisions to operate require very careful consideration. This should include discussion of issues around risk versus benefit, futility and realistic longer-term outcomes, e.g. requirement for nursing home care. This should also...

Failure to recognise and treat the deteriorating patient (‘failure to rescue’) has been has been shown to increase mortality, particularly in the elderly surgical patient, and so hospitals should have policies in place to prevent this.^113,114 Audits should be undertaken to ensure the effectiveness and compliance of these policies.

Most children are fit and healthy, and straightforward surgery can be planned on a day case basis. Routine blood testing is rarely necessary. There are exceptions to this such as sickle cell status.^18,19

Previous ‘do not attempt cardiopulmonary resuscitation’ (DNACPR) orders are not necessarily a contraindication to surgery and should be reviewed on a case by case basis by the multidisciplinary team, in discussion with the patient and their next of kin, prior to anaesthesia if at all possible.^115,116

There should be adequate critical care facilities to allow the timely admission of high risk general surgical patients.¹⁴ Preoperative risk stratification should inform the decision making process for critical care admission.^1,72

Critical care should be considered for all patients requiring emergency surgery. There should be close preoperative liaison and communication between the surgical, anaesthetic and critical care teams, with the common goal of ensuring appropriate safe care in the best interests of the patient.³³

All high risk patients should be considered for critical care. As a minimum, patients with an estimated risk of death of ≥10% should be admitted to a critical care location (unless there is a contraindication).³ The 10% threshold for risk of death is historical and should be perceived as an absolute minimum standard. The exact percentage mortality risk that...

Hospital level audit data should be examined to determine whether national standards for postoperative critical care admission are being adhered to. Where compliance is poor, a change of local policies and reconfiguration of services should be considered, to enable all high risk emergency laparotomy patients to be cared for on a critical care unit after surgery.¹   

Anaesthesia for children should be undertaken or supervised by senior anaesthetists who have undergone appropriate training. In the UK, all anaesthetists with a CCT or equivalent will have obtained higher paediatric anaesthetic training. There will be anaesthetists who have acquired more advanced competencies, thus allowing provision of a more extensive anaesthetic service, and those competencies should be maintained. Unless there...