Crispin Schneider1, Laura E Tyler2, Eleanor F Scull2, Belinda J Pryle2, Hugh Barr2. 1. Department of General Surgery, Gloucestershire Hospitals NHS Foundation Trust, UK. Electronic address: crispin.schneider.13@ucl.ac.uk. 2. Department of General Surgery, Gloucestershire Hospitals NHS Foundation Trust, UK.
Abstract
BACKGROUND: Emergency laparotomy (EL) is a procedure that puts a strain on healthcare resources and is associated with a significant morbidity and mortality. Despite these implications little improvement in the outcome of patients undergoing this procedure has been made in the UK over the last few decades. A delay in transferring patients to theatre has been shown to negatively affect outcome of EL. A prospective case-control study was carried out to evaluate which preoperative factors may contribute towards a delay in theatre transfer. METHODS: The time between decision to operate and anaesthetic start time was recorded for all patients undergoing EL between April and September 2013 at Gloucestershire Royal Infirmary. Patient selection criteria were based on the National Emergency Laparotomy Audit guidelines. Patients were divided into two groups depending on whether the transfer to theatre was delayed or not. Binary logistic regression analysis was performed on perioperative factors to determine independent predictors of delay. RESULTS: A total of 84 EL were included for analyses with 31 classified as delayed. In the delayed group time for theatre transfer was increased at 6.9 vs. 2.3 h (p < 0.005) respectively. Unavailability of emergency theatres due to other cases taking priority was the most frequent cause for delay (n = 24). On binary logistic regression analysis, indication for laparotomy (OR 4.96, CI 1.4-17.6, p < 0.05), patient age (OR 1.04, CI 1.00-1.07, p < 0.04) and presence of a consultant surgeon (OR 0.16, CI 0.03-0.79, p < 0.03) were found to be independent predictors of delay in EL. CONCLUSION: In this study, factors that were associated with a delay in commencing EL were operative indication and patient age whereas the presence of a consultant surgeon made a delay less likely. These findings may highlight points of interest for researchers analysing and auditing the provision of EL in the UK.
BACKGROUND: Emergency laparotomy (EL) is a procedure that puts a strain on healthcare resources and is associated with a significant morbidity and mortality. Despite these implications little improvement in the outcome of patients undergoing this procedure has been made in the UK over the last few decades. A delay in transferring patients to theatre has been shown to negatively affect outcome of EL. A prospective case-control study was carried out to evaluate which preoperative factors may contribute towards a delay in theatre transfer. METHODS: The time between decision to operate and anaesthetic start time was recorded for all patients undergoing EL between April and September 2013 at Gloucestershire Royal Infirmary. Patient selection criteria were based on the National Emergency Laparotomy Audit guidelines. Patients were divided into two groups depending on whether the transfer to theatre was delayed or not. Binary logistic regression analysis was performed on perioperative factors to determine independent predictors of delay. RESULTS: A total of 84 EL were included for analyses with 31 classified as delayed. In the delayed group time for theatre transfer was increased at 6.9 vs. 2.3 h (p < 0.005) respectively. Unavailability of emergency theatres due to other cases taking priority was the most frequent cause for delay (n = 24). On binary logistic regression analysis, indication for laparotomy (OR 4.96, CI 1.4-17.6, p < 0.05), patient age (OR 1.04, CI 1.00-1.07, p < 0.04) and presence of a consultant surgeon (OR 0.16, CI 0.03-0.79, p < 0.03) were found to be independent predictors of delay in EL. CONCLUSION: In this study, factors that were associated with a delay in commencing EL were operative indication and patient age whereas the presence of a consultant surgeon made a delay less likely. These findings may highlight points of interest for researchers analysing and auditing the provision of EL in the UK.
Authors: Daniel I McIsaac; Karim Abdulla; Homer Yang; Sudhir Sundaresan; Paula Doering; Sandeep Green Vaswani; Kednapa Thavorn; Alan J Forster Journal: CMAJ Date: 2017-07-10 Impact factor: 8.262