Aims NELA has been instrumental at improving perioperative care and 30–day mortality following emergency laparotomy (EmLap); long-term outcomes and follow-up are less well reported. This study aims to establish the unscheduled and scheduled service use of EmLap patients after discharge. Methods This is a single-centre service evaluation. Patients were included if they had an EmLap recorded from 2016-2019 at our local institute and were alive on discharge. Outcomes were 30-day readmission rate and outpatient follow-up. Results 944 patients were included. 11.9% re-presented to the surgical department within 30-days; 58.0% of these needed readmissions. The most common causes for re-presentation (n = 112) were management of a wound issue (15.2%), ongoing pain without evidence of complication (10.7%) and ongoing intra-abdominal sepsis (9.8%). 1-year survival was 81.4%. Of these (n = 856); 74.3% were invited to outpatients; DNA rate was 8.8%, with only 67.8% of patients having a follow-up review. Median time to follow up was 9 weeks. Patients were more likely to be invited for outpatient review if they had a new stoma (OR 2.56, 95% CI 1.81 – 3.56), and less likely if adhesiolysis was the primary procedure (OR 0.55, 95% 0.39-0.76). Patients who failed to attend an appointment were significantly younger (median age 53 vs. 60 years, p = 0.0033) and from more deprived areas (average WIMD 673.6 vs 977.3, p = 0.002). Conclusion This study demonstrates higher levels of unscheduled care and lower levels of scheduled care than expected. Care standards should be extended beyond the 30-day milestone to fully appreciate the morbidity associated from EmLap.
Introduction Emergency laparotomy (EmLap) is a “life-saving” procedure, but little is known about how “life-changing” it can be. This study aims to establish the impact of EmLap on PROMs and PREMs. Methods All surviving patients who had an EmLap from 2016–2019 were included. Eligible patients were invited to complete a postal questionnaire. Responses underwent qualitative and logistical regression analysis. Results Response rate was 42.6% (n=310). 11.3% reported that they had not resumed intimacy post-op. Patients were less likely to resume intimacy if they were >80 years (OR 10.500, p0.003), had a return to theatre (OR 5.111, p0.017), IBD diagnosis (OR 5.00, p0.009) or stoma (OR 4.906, p0.003). Patients were more likely to change employment if female (OR 2.858, p0.009), more comorbid (ASA3 OR 5.000, p0.024), had a stoma (OR 4.006, p<0.001), or incisional hernia (OR 4.228, p<0.001). Qualitative analysis revealed deconditioning, lack of employer support, and delays to reconstructive surgery were the main reasons for not returning to work. Qualitative analysis of experience exposed a number of unmet needs: surgical “debrief” and “what to expect” (33.6%), surgical aftercare (25.2%), mental-health support (22.6%) and timely restorative surgery (11.7%). 88.1% felt a specialist nurse would have improved their experience. Patients were more likely to have reported a negative experience if they had benign disease (p0.010). Conclusion This is the first study to describe PROMS and PREMS following EmLap, and also to identify patients at risk of poor outcome. It advocates the need for an EmLap specialist nurse to facilitate holistic care.
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