High-Risk Emergency Laparotomy in Australia: Comparing NELA, P-POSSUM, and ACS-NSQIP Calculators

Eliezer, Dilharan; Holmes, M; Sullivan, Gavin; Gani, Jon; Pockney, Peter; Gould, Tiffany; Gramlick, Madelyn; Rugendyke, Anya; Ming, Joyce; Jones, Shaun B.; Coleman, Hannah; Hawthorne, Jacqueline; Green, Sam; Zardawi, Daniel; Hampton, Jacob; Francis, Gabrielle

doi:10.1016/j.jss.2019.09.024

Cited by 29 publications

(23 citation statements)

References 8 publications

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“…Of the 33 included studies, four were from NZ, 1,10,12,13 six from Australia, 2,5,6,14-16 11 from the UK, 3,4,[17][18][19][20][21][22][23][24][25] seven from Denmark, 7,[26][27][28][29][30][31] five from the USA [32][33][34][35][36] and one from Pakistan. 37 Ten papers were from a single centre studies, 10,12,13,22,23,25,26,28,32,37 nine were multi-centre studies 3,[5][6][7][14][15][16][17]27,29 and 17 were whole country studies. 1,2,4,...…”

Section: Resultsmentioning

confidence: 99%

“…37 Ten papers were from a single centre studies, 10,12,13,22,23,25,26,28,32,37 nine were multi-centre studies 3,[5][6][7][14][15][16][17]27,29 and 17 were whole country studies. 1,2,4,[18][19][20][21]24,30,31,[33][34][35][36] Twenty-five studies were retrospective 1,2,[4][5][6][7]10,12,13,15,[18][19][20][21][24][25][26]…”

Section: Resultsmentioning

confidence: 99%

“…1,2,4 The most common reasons for an EL both in NZ and Australia are intestinal obstruction, intestinal perforation, appendicitis, and cholecystitis. 1,5,6 The four most common procedures carried out during an EL are small bowel resection, adhesiolysis, right colectomy and Hartmann's procedure. 4 EL is recognized as a high-risk procedure with subsequent high morbidity and mortality.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

New Zealand and Australia emergency laparotomy mortality rates compare favourably to international outcomes: a systematic review

Fagan

Barazanchi

Coulter

et al. 2021

ANZ Journal of Surgery

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Background: Almost 20 000 people undergo an emergency laparotomy each year in New Zealand and Australia. Common indications include small and large bowel obstruction, and intestinal perforation. Considered a high-risk procedure, emergency laparotomy is associated with significantly high morbidity and mortality. The aim of this review was to identify and compare 30-day, 90-day and 1-year mortality rates following emergency laparotomy in New Zealand and Australia. Methods: A systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Electronic searches were performed in Medline, Embase, PubMed and Scopus in April 2020. Results: Thirty-three papers met the inclusion criteria. Studies ranged in size from 58 to 75 280 patients. Weighted mean 30-day mortality was 8.40% (8.39-8.41). Mortality rates increased with longer postoperative follow up with 90-day weighted mortality rate of 14. 14% (14.13-14.15) and the weighted mortality rate at 1 year of 24.60% (24.56-24.66). There was significant variability in mortality rates between countries. Conclusion: There is a wide variability of 30-day, 90-day and 1-year mortality rates internationally. Lowering postoperative mortality rates following emergency laparotomy through quality improvement initiatives could result in up to 120 lives in New Zealand and over 250 lives in Australia being saved each year. The continued work of the Australian and New Zealand Emergency Laparotomy Audit -Quality Improvement is crucial to improving emergency laparotomy mortality rates further in New Zealand and Australia.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

New Zealand and Australia emergency laparotomy mortality rates compare favourably to international outcomes: a systematic review

Fagan

Barazanchi

Coulter

et al. 2021

ANZ Journal of Surgery

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“…More recent studies suggest 30-day mortality is now lower and in Australia the contemporary 30-day mortality is between 7% and 9%. [9][10][11][12][13][14][15] In this high-risk group, some deaths will be inevitable and the potentially preventable 30-day mortality is likely to be even lower. Attention has already turned to the additional mortality that occurs during the subsequent 12 months, especially as the intervening period is often associated with a poor quality of life.…”

Section: Discussionmentioning

confidence: 99%

Two‐year outcomes from the Australian and New Zealand Emergency Laparotomy Audit‐Quality Improvement pilot study

Aitken

Griffiths

Acker

et al. 2021

ANZ Journal of Surgery

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Background: The aim of the Australian and New Zealand Emergency Laparotomy Audit-Quality Improvement (ANZELA-QI) pilot study was to determine (i) the outcomes of emergency laparotomy (EL) and (ii) the feasibility of a national, multi-disciplinary quality improvement (QI) project based on a bundle of evidence-based care standards. Methods: An online database was created using the Research Electronic Data Capture (REDCap) programme. National ethics approval with waiver of consent was obtained. Data were entered directly onto REDCap and extracted monthly for eight care standards (preoperative consultant radiologist reporting of computed tomography scans, preoperative mortality risk score, consultant presence in theatre, timely access to theatre and critical care commensurate with risk and involvement of aged care). Monthly QI run charts using 'traffic' light graphics (green ≥80%, amber ≥50% to <80% and red <50%) reported compliance with the standards. Results: Sixty hospitals indicated interest, but difficulties with site-specific ethics approval resulted in only 24 hospitals participating (2886 EL in 2755 patients). The overall inhospital mortality was 7.1% (2.3%-13.3%) and average length of stay 15.5 (8.6-22.7) days. Both significantly declined. Preoperative risk assessment (overall 45%) improved almost three-fold during the study. Only 60% had timely access to theatre and only 70% with a predicted mortality risk of >10% were admitted to critical care. Conclusion: Overall mortality compared favourably with similar international studies and declined in association with participation in the audit. Compliance with some care standards shows considerable scope to improve EL care using QI methodology. † Key standards were based on NELA's original standards of care. ‡ Green (bold) RAGG rated: standard met by ≥80% of patients; amber (italics): standard met by ≥50% to 80% of patients; red (bold italics): standard met by <50% of patients. § Total number of hospitals = 24.

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“…There is a lack of consensus on the definition of frailty in the literature, and this term has been used subjectively. 4 , 12 , 17 ) It often denotes unintentional weight loss, exhaustion, weakness, slow walking, low physical activity, and lack of phenotype. 4 , 18 ) The Clinical Frailty Scale has been used to apply a more consistent definition.…”

Section: Introductionmentioning

confidence: 99%

Association of Preoperative Risk Factors and Mortality in Older Patients following Emergency Abdominal Surgery: A Retrospective Cohort Study

Hacım

Akbaş

Ulgen

et al. 2021

Ann Geriatr Med Res

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Authors' contributions are as follows:NAH and AA researched literature and conceived the study. NAH, YU, MT and GE was involved in protocol development, gaining ethical approval, patient recruitment, and data acquisition. YA and SM was involved in data analysis. NAH, TVA and OK wrote the first draft of the manuscript. All authors reviewed and edited the manuscript and approved the final version of the manuscript.

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High-Risk Emergency Laparotomy in Australia: Comparing NELA, P-POSSUM, and ACS-NSQIP Calculators

Cited by 29 publications

References 8 publications

New Zealand and Australia emergency laparotomy mortality rates compare favourably to international outcomes: a systematic review

New Zealand and Australia emergency laparotomy mortality rates compare favourably to international outcomes: a systematic review

Two‐year outcomes from the Australian and New Zealand Emergency Laparotomy Audit‐Quality Improvement pilot study

Association of Preoperative Risk Factors and Mortality in Older Patients following Emergency Abdominal Surgery: A Retrospective Cohort Study

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