More patients die from emergency laparotomy (bowel surgery) than any other type of high-risk planned surgery, the First Patient Audit Report of the National Emergency Laparotomy Audit has found and the primary reason is that the care and resources provided do not match those generally provided for patients undergoing high-risk planned operations.
The report published on June 30, 2015 outlines the results, conclusions and recommendations from the audit.
For those of you who are unaware, emergency laparotomy (bowel surgery) is a high-risk surgical operation that involves making an incision to operate inside the abdomen to treat life threatening conditions.
According to The National Emergency Laparotomy Audit (NELA), 11 per cent of patients who undergo emergency laparotomy die within 30 days of their operation. This is up to five times higher than planned surgery including cardiac and cancer surgery, where key resources such as consultant led care and critical care are more readily provided.
The report authors suggest that resources and other standards of care need to be provided to these emergency cases on a comparable level to that provided for planned elective operations such as cardiac surgery and planned major bowel surgery.
For the audit, as many as 20,000 patients from 192 hospitals were observed. The authors reveal that they observed major variation in death rates between patient groups: for example 3 per cent of patients under 50 died in hospital within 30 days compared to 18 per cent of those over 70 years old. More than a quarter of patients required hospital treatment for more than 20 days, indicating significant levels of complications affecting patients and families, and major costs to the NHS.
This is the first time that this information has ever been comprehensively collected. It is encouraging to note that some hospitals are achieving recommended standards of care for every standard evaluated, indicating that it should be possible for all hospitals to improve their performance and therefore reduce death and complications after this type of surgery.
These are some of the findings of the NELA which has today revealed a wide variation in care across England and Wales, against existing, clearly defined standards of care. NELA, commissioned by the Healthcare Quality Improvement partnership (HQIP) as part of the National Clinical Audit Programme, provides named hospital-level data from 192 of the 195 hospitals in England and Wales that carry out emergency bowel surgery.
Particular areas of concern which were highlighted include:
- Risk of death after surgery was documented in only just over half of patients. Patients who had their risk documented were more likely to be allocated appropriate resources and receive care that met standards for best practice, such as consultant delivered care and critical care.
- One in six patients did not arrive in the operating theatre within the recommended timeframes, despite the urgent nature of the surgery.
- A stark contrast with planned surgery was evident in admission rates to critical care after surgery (where higher levels of nursing care, monitoring and life-supporting treatment can all be provided). Critical care admission would be considered routine practice for 100% of patients undergoing much lower risk planned cardiac surgery; however, only 60% were admitted there directly after emergency bowel surgery.
