EMERGENCY SURGERY
Report author, Candace Imison, Nuffield Trust director of policy, commented: “The fact that there are such big differences in what happens to patients undergoing this type of surgery is very worrying. Our report examines various solutions to the problem, but finds that the quickest gains could be achieved simply by systematically implementing all the evidence-based guidelines that already exist. This should be the top priority for all hospitals offering emergency general surgery.” Mr John Abercrombie, RCS council member for general surgery, said: “Patients who face life-threatening injuries and major trauma are generally treated well by the NHS. However, the standard of care of other emergency and critically-ill patients needing urgent treatment is highly variable across hospitals and has fallen behind other Western countries. “Over the last few decades the NHS has rightly spent a lot of time and money improving planned care for patients. This important report from the Nuffield Trust demonstrates we now need the same determination and priority given to improving the care of some of the sickest patients in the NHS.”
Emergency laparotomy: audit results
A joint national report led by the Royal College of Anaesthetists (RCoA) has also shown that a lack of consistent care for patients undergoing high-risk emergency
There are unacceptable differences between hospitals in outcomes for patients undergoing emergency general surgery.
bowel surgery may be negatively affecting patient outcomes and placing major strain on scarce NHS resources. To combat the variation in the levels of care provided across NHS hospitals, the report makes 12 recommendations to health commissioners and providers. Commissioned by the Healthcare Quality Improvement Partnership as part of the National Clinical Audit Programme, the National Emergency Laparotomy Audit (NELA) report analyses the care received by more than 20,000 emergency bowel surgery patients treated in NHS hospitals in England and Wales between December 2014 and November 2015. Analysing patients’ short-term survival, the
report found 1 in 9 patients died within 30 days of surgery, but that risk of death ranged from under 5% to over 30%, depending on the patient’s condition at the time of surgery. The 30-day mortality rates for individual hospitals were in the range expected given the number of patients and the range of conditions treated; however, the report shows substantial variation in the delivery of care against pre-existing national standards. Data from this report highlights that the current provision of care is falling short of that
provided for adult patients undergoing other major elective surgery of comparable or lesser risk. NELA’s first patient report, published in 2015, revealed that more patients die from emergency bowel surgery than from any other type of high-risk planned surgery. Office for National Statistics and NELA data indicate that emergency laparotomy carries an 11% mortality rate, confirming the high-risk nature of emergency bowel surgery. More than a quarter remained in hospital 20 days after surgery, with older patients more likely to remain in hospital longer.
Examples of where hospitals fall short of the standards of care referenced within the NELA report include: l Prior to surgery, 36% of patients do not receive a documented assessment of risk of death.
l 29% of emergency bowel surgery patients identified as urgent do not arrive in theatre within the stipulated two hour timeframe.
l 39% of patients are not admitted directly to a critical care unit after surgery.
l 90% of elderly patients did not receive input from elderly medicine specialists. Though the proportion of patients receiving a formal risk assessment prior to bowel surgery
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