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Frailty and Emergency Laparotomy Ethics — FRCA Final MCQ

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HardMedicolegal & EthicsFrailty and Emergency Laparotomy EthicsFRCA Final

A 70-year-old man (ASA III) with severe frailty (Clinical Frailty Scale 7/9) and advanced dementia is referred for emergency laparotomy for large bowel obstruction. The surgical team feel surgery is the only curative option. What is the most important pre-operative consideration for the anaesthetist?

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Correct answer: A — Determining whether surgery is in the patient's best interests through a multidisciplinary best interests discussion

In a patient with severe frailty (CFS 7 – severely frail, completely dependent) and advanced dementia, the most critical consideration is whether major surgery is in the patient's best interests. The perioperative mortality for frail elderly patients undergoing emergency laparotomy can exceed 50%. A multidisciplinary best interests discussion (involving surgeon, anaesthetist, intensivist, nursing staff, family/next of kin, and where appropriate palliative care) is essential. Non-operative management or palliation may be more appropriate. This is a Mental Capacity Act 2005 best interests decision.

Reference: NELA – 2023 – National Emergency Laparotomy Audit; Mental Capacity Act – 2005; RCOA – 2023 – Perioperative care of the elderly