Proceedings of resources for optimal care of acute care and emergency surgery consensus summit Donegal Ireland

Sugrue, Michael; Maier, Ron; Moore, Ernest E.; Boermeester, Marja A.; Catena, Fausto; Leppäniemi, Ari; Peitzman, Andrew B.; Velmahos, George C.; Ansaloni, Luca; Abu‐Zidan, Fikri M.; Balfe, Paul; Bendinelli, Cino; Biffl, Walt; Bowyer, Mark W.; DeMoya, Marc; Waele, Jan J. De; Saverio, Salomone Di; Drake, Anne; Fraga, Gustavo Pereira; Hallal, Ali; Henry, Colm; Hodgetts, Timothy; Hsee, Li; Huddart, S.; Kirkpatrick, A. W.; Kluger, Yoram; Lawler, Leo P.; Malangoni, Mark A.; Malbrain, Manu L N G; MacMahon, Peter; Mealy, K.; O’Kane, Maurice; Loughlin, Paula; Paduraru, Mihai; Pearce, Lyndsay; Pereira, Bruno M.; Priyantha, A.; Sartelli, Massimo; Søreide, Kjetil; Steele, Chris; Thomas, Scott; Vincent, Jean‐Louis; Woods, Lisa

doi:10.1186/s13017-017-0158-x

Cited by 21 publications

(19 citation statements)

References 14 publications

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“…Similarly, this study emphasises the need for effective governance for EAS. National audits implemented in the UK8 and Australia29 reduced mortality rates in emergency general surgery and a series of quality benchmarks or key performance indicators have been proposed 30 31. Implementation of a prospective, NELA-like audit process could allow for analysis of specific factors contributing to improved outcomes in high-volume hospitals.…”

Section: Discussionmentioning

confidence: 99%

Volume and in-hospital mortality after emergency abdominal surgery: a national population-based study

et al. 2019

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ObjectivesEmergency abdominal surgery (EAS) refers to high-risk intra-abdominal surgical procedures undertaken for acute gastrointestinal pathology. The relationship between hospital or surgeon volume and mortality of patients undergoing EAS is poorly understood. This study examined this relationship at the national level.DesignThis is a national population-based study using a full administrative inpatient dataset (National Quality Assurance Improvement System) from publicly funded hospitals in Ireland.Setting24 public hospitals providing EAS services.Participants and InterventionsPatients undergoing EAS as identified by primary procedure codes during the period 2014–2018.Main outcome measuresThe main outcome measure was adjusted in-hospital mortality following EAS in publicly funded Irish hospitals. Mortality rates were adjusted for sex, age, admission source, Charlson Comorbidity Index, procedure complexity, organ system and primary diagnosis. Differences in overall, 7-day and 30-day in-hospital mortality for hospitals with low (<250), medium (250–449) and high (450+) volume and surgical teams with low (<30), medium (30–59) and high (60+) volume during the study period were also estimated.ResultsThe study included 10 344 EAS episodes. 798 in-hospital deaths occurred, giving an overall in-hospital mortality rate of 77 per 1000 episodes. There was no statistically significant difference in adjusted mortality rate between low and high volume hospitals. Low volume surgical teams had a higher adjusted mortality rate (85.4 deaths/1000 episodes) compared with high volume teams (54.7 deaths/1000 episodes), a difference that persisted among low volume surgeons practising in high volume hospitals.ConclusionPatients undergoing EAS managed by high volume surgeons have better survival outcomes. These findings contribute to the ongoing discussion regarding configuration of emergency surgery services and emphasise the need for effective clinical governance regarding observed variation in outcomes within and between institutions.

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Section: Discussionmentioning

confidence: 99%

Volume and in-hospital mortality after emergency abdominal surgery: a national population-based study

et al. 2019

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“…60 Given the frequency of appendicitis, readmission has significant cost implications and the surgical community are increasingly recognizing the need to measure and improve outcomes. [61][62][63] This meta-analysis is one of the first to look at readmission, as previous meta-analyses of patients undergoing appendectomy and appendicitis have focused on diagnosis, 64 and surgical approaches, such as laparoscopic versus open techniques. 65 While there may be a role for conservative management in some clinical situations, most patients currently will undergo surgery rather than non-operative management of their appendicitis.…”

Section: Discussionmentioning

confidence: 99%

Meta‐analysis of unplanned readmission to hospital post‐appendectomy: an opportunity for a new benchmark

Bailey

Choynowski

Kabir

et al. 2019

ANZ Journal of Surgery

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Background Appendicitis is the most common cause of acute abdominal pain requiring surgical intervention. While many studies report readmission, a meta‐analysis of readmission post‐appendectomy has not been published. This meta‐analysis was undertaken to determine rates and predictors of hospital readmission following appendectomy and to potentially provide a metric benchmark. Methods An ethically approved PROSPERO‐registered (ID CRD42017069040) meta‐analysis following Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines, using databases PubMed and Scopus, was undertaken for studies published between January 2012 and June 2017. Articles relating to outcomes and readmissions after appendectomy were identified. Those scoring >15 for comparative studies and >10 for non‐comparative studies, using Methodological Index for Non‐Randomized Studies criteria were included in the final analysis. The odds ratios (OR) using random‐effects, Mantel–Haenszel method with 95% confidence intervals (CI), were computed for each risk factor with RevMan5. Results A total of 1757 articles reviewed were reduced to 45 qualifying studies for a final analysis of 836 921 appendectomies. 4.3% (range 0.0–14.4%) of patients were readmitted within 30 days. Significant preoperative patient factors for increased readmission were diabetes mellitus (OR 1.93, CI 1.63–2.28, P < 0.00001), complicated appendicitis (OR 3.6, CI 2.43–5.34, P < 0.00001) and open surgical technique (OR 1.39, CI 1.08–1.79, P < 0.00001). Increased readmission was not associated with gender, obesity or paediatric versus general surgeons or centres. Conclusion This meta‐analysis identified that readmission is not uncommon post‐appendectomy, occurring in one in 25 cases. The mean readmission rate of 4.3% may act as a quality benchmark for improving emergency surgical care. Targeting high‐risk groups with diabetes or complicated appendicitis and increasing use of laparoscopic technique may help reduce readmission rates.

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“…This includes incident monitoring, effective use of clinical indicators (key performance indicators, KPIs), peer review meetings, morbidity and mortality meetings as well as audits . KPIs are developed to assess, monitor and improve provision of care in EGS . Operative indicators can be general or surgery‐specific and include: time to surgery, LOS, procedure‐related complications (such as bile duct injury in cholecystectomy), rate of in‐hours operating, theatre turnaround time and unplanned return to theatre.…”

Section: Review Of Gsa 12‐point Planmentioning

confidence: 99%

“…55 KPIs are developed to assess, monitor and improve provision of care in EGS. 56 Operative indicators can be general or surgery-specific and include: time to surgery, LOS, procedure-related complications (such as bile duct injury in cholecystectomy), rate of in-hours operating, theatre turnaround time and unplanned return to theatre. Broader clinical indicators include time to surgical review and meeting the ED '4-h rule'.…”

Section: Egs Should Be Consultant Ledmentioning

confidence: 99%

General Surgeons Australia's 12‐point plan for emergency general surgery

Ang

Wong

Truskett

2019

ANZ Journal of Surgery

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In the last decade, emergency general surgery (EGS) in Australia and New Zealand has seen a transition from the traditional on‐call system to the acute surgical unit (ASU) model. The importance and growing demand for EGS has resulted in the implementation of the General Surgeons Australia's 12‐point plan for emergency surgery. Since its release, the 12‐point plan has been used as a benchmark of a well‐functioning ASU, both locally and abroad. This study aims to provide a descriptive review on the relevance of the 12‐point plan to the ASU model and review the current evidence to support this framework. The review concludes that the establishment of the ASU model has met the aims set out by the Royal Australasian College of Surgeons for EGS. The 12‐point plan is relevant and has good evidence to support its framework.

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Proceedings of resources for optimal care of acute care and emergency surgery consensus summit Donegal Ireland

Cited by 21 publications

References 14 publications

Volume and in-hospital mortality after emergency abdominal surgery: a national population-based study

Volume and in-hospital mortality after emergency abdominal surgery: a national population-based study

Meta‐analysis of unplanned readmission to hospital post‐appendectomy: an opportunity for a new benchmark

General Surgeons Australia's 12‐point plan for emergency general surgery

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