Audit of emergency laparotomy undertaken at the royal derby hospital compared to the results of the UK emergency laparotomy network; do we meet the optimum standards of care?

Abstract

Introduction: To compare our performance locally at The Royal Derby Hospital against the recently published National Emergency Laparotomy Audit by the Emergency Laparotomy Network. Methods: Prospective data were collected over a three month period, totalling 85 patients undergoing emergency laparotomy. Data included grade of surgeon and anaesthetist, time of procedure and post-operative destination, and 30 day mortality figures. Results: Mortality locally was similar in all the age groups compared with NELA (P>0.05). Overall 30-day mortality was 14% in the local audit versus 14.9% nationally. Factors found to affect 30-day mortality ranged from underlying pathology to the timing of surgery, with a higher mortality of 20% for the 27/85 cases undertaken 'out of hours' (00:00-07:59) compared with 10% 'in hours' (08:00-17:59). Mortality appears to correlate with involvement of consultant anaesthetists/surgeons as more were present 'in hours'. Post-operative destination was highlighted locally as an area for improvement; 30-day mortality was 17% for patients returning to ICS level 0 care, versus 10% (level 1/2) and 16% (level 3). Conclusions: This study gave insights into current local management of a particularly high-risk patient group. Improved utilisation of critical care units and outreach teams in support of such patients has resulted from this audit.