Emergency major abdominal surgery – ‘The times they are a‐changing’

Huddart, S.; Peden, Carol J.; Quiney, Nial

doi:10.1111/codi.12198

Cited by 10 publications

(7 citation statements)

References 21 publications

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“…Median length of hospital stay was 10 (i.q.r. [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] days in the control group and 11 (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21) days in the intervention group (P = 0⋅783). Median length of ICU stay was 5 (2-17) and 3 (1-9) days respectively (P = 0⋅018).…”

Section: Resultsmentioning

confidence: 99%

“…Despite a large number of patients undergoing acute high‐risk abdominal (AHA) surgery with a high risk of morbidity and mortality, and substantial socioeconomic costs, there has been limited focus on optimized surgical regimens to improve surgical outcomes. The traditional perioperative treatment of patients undergoing AHA surgery is controversial and founded primarily on non‐standardized treatment practice rather than evidence, and cultural and logistic challenges in emergency surgery are being debated. Only a few standardized perioperative protocols have been launched to improve outcomes after AHA surgery.…”

Section: Introductionmentioning

confidence: 99%

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Multidisciplinary perioperative protocol in patients undergoing acute high-risk abdominal surgery

Tengberg

Bay‐Nielsen

Bisgaard

et al. 2017

British Journal of Surgery

113

150

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Multidisciplinary perioperative protocol in patients undergoing acute high-risk abdominal surgery

Tengberg

Bay‐Nielsen

Bisgaard

et al. 2017

British Journal of Surgery

113

150

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“…Most recently, a large prospective study of 4920 patients undergoing emergency laparotomy in Denmark reported a 19·5 per cent mortality rate. In the UK there is increasing recognition that outcomes after emergency major general surgery are poor and would benefit from standardization of care.…”

Section: Introductionmentioning

confidence: 99%

Use of a pathway quality improvement care bundle to reduce mortality after emergency laparotomy

Huddart

Peden

Swart

et al. 2014

British Journal of Surgery

182

206

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BackgroundEmergency laparotomies in the UK, USA and Denmark are known to have a high risk of death, with accompanying evidence of suboptimal care. The emergency laparotomy pathway quality improvement care (ELPQuiC) bundle is an evidence-based care bundle for patients undergoing emergency laparotomy, consisting of: initial assessment with early warning scores, early antibiotics, interval between decision and operation less than 6 h, goal-directed fluid therapy and postoperative intensive care.MethodsThe ELPQuiC bundle was implemented in four hospitals, using locally identified strategies to assess the impact on risk-adjusted mortality. Comparison of case mix-adjusted 30-day mortality rates before and after care-bundle implementation was made using risk-adjusted cumulative sum (CUSUM) plots and a logistic regression model.ResultsRisk-adjusted CUSUM plots showed an increase in the numbers of lives saved per 100 patients treated in all hospitals, from 6·47 in the baseline interval (299 patients included) to 12·44 after implementation (427 patients included) (P < 0·001). The overall case mix-adjusted risk of death decreased from 15·6 to 9·6 per cent (risk ratio 0·614, 95 per cent c.i. 0·451 to 0·836; P = 0·002). There was an increase in the uptake of the ELPQuiC processes but no significant difference in the patient case-mix profile as determined by the mean Portsmouth Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity risk (0·197 and 0·223 before and after implementation respectively; P = 0·395).ConclusionUse of the ELPQuiC bundle was associated with a significant reduction in the risk of death following emergency laparotomy.

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“…Thirty-day mortality is approximately 45% and complication rates approximately 70% in octogenarians [9,10]. The number of elderly patients undergoing emergency surgery is increasing, and initiatives aimed at improving complication-free survival are urgently needed [11,12].…”

Section: Introductionmentioning

confidence: 99%

Complications after emergency laparotomy beyond the immediate postoperative period - a retrospective, observational cohort study of 1139 patients

et al. 2016

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Mortality and morbidity occur commonly following emergency laparotomy, and incur a considerable clinical and financial healthcare burden. Limited data have been published describing the postoperative course and temporal pattern of complications after emergency laparotomy. We undertook a retrospective, observational, multicentre study of complications in 1139 patients after emergency laparotomy. A major complication occurred in 537/1139 (47%) of all patients within 30 days of surgery. Unadjusted 30-day mortality was 20.2% and 1-year mortality was 34%. One hundred and thirty-seven of 230 (60%) deaths occurred between 72 h and 30 days after surgery; all of these patients had complications, indicating that there is a prolonged period with a high frequency of complications and mortality after emergency laparotomy. We conclude that peri-operative, enhanced recovery care bundles for preventing complications should extend their focus on continuous complication detection and rescue beyond the first few postoperative days.

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Emergency major abdominal surgery – ‘The times they are a‐changing’

Cited by 10 publications

References 21 publications

Multidisciplinary perioperative protocol in patients undergoing acute high-risk abdominal surgery

Multidisciplinary perioperative protocol in patients undergoing acute high-risk abdominal surgery

Use of a pathway quality improvement care bundle to reduce mortality after emergency laparotomy

Complications after emergency laparotomy beyond the immediate postoperative period - a retrospective, observational cohort study of 1139 patients

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