Comparing predicted and observed morbidity and mortality between emergency laparotomies conducted during the day and overnight at a district general hospital

AbstractBackground:Tonsillectomy is a common, low-risk procedure. Post-tonsillectomy haemorrhage remains the most serious complication. Recent nationwide studies in the UK have identified an increased morbidity and mortality for both high-risk and low-risk elective general surgery performed at the weekend.Methods:Data for tonsillectomies performed at a district general hospital over a three-year period were retrospectively reviewed. The same group of surgeons performed elective tonsillectomies on both weekends and weekdays. All patients who developed a post-tonsillectomy haemorrhage were identified and the day of original operation was noted.Results:Between 2010 and 2013, 2208 (94.00 per cent) elective tonsillectomies were performed on a weekday and 141 (6.00 per cent) were performed on the weekend. Post-tonsillectomy haemorrhages occurred in 104 patients (4.71 per cent) who underwent their procedure on a weekday and in 10 patients (7.09 per cent) who had their surgery at the weekend (p = 0.20).Conclusion:There is no difference in the rate of post-tonsillectomy haemorrhage for procedures performed on a weekday or weekend.

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553 Quality Improvement: The Implementation of Routine Tertiary Trauma Survey in all Trauma Patients Aged Over 60 Years in a Busy District General Hospital

British Journal of Surgery ◽

10.1093/bjs/znab134.451 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

C Hughes ◽

A Berry

Keyword(s):

Quality Improvement ◽

Patient Care ◽

General Hospital ◽

District General Hospital ◽

Morbidity And Mortality ◽

Trauma Patients ◽

Routine Patient Care ◽

Missed Injury

Abstract Introduction Missed injury (MI) in trauma-patients is a widely reported phenomenon, with rates varying from 1.9-39%. Methods exist to reduce the incidence of MI’s such as the tertiary-trauma-survey (TTS). Robust primary and secondary surveys should indeed identify all injuries and facilitate management. However, for trauma patients, there remains an unwanted prevalence of MI. We hypothesized the addition of TTS may reduce the incidence of MI in a District General Hospital (DGH) and reduce associated morbidity and mortality; in particular in those aged >60. Method Patient notes for 18 consecutive trauma admissions in those >60 years were audited for admission demographics, timing and outcome of primary, secondary, and tertiary surveys, and occult injury. The TTS bundle was subsequently implemented in all trauma inpatients >60. Results In the primary round, 11% (n = 2) had evidence of TTS within 36hr of admission, reflective of exceeding the TARN criterion. TTS is now being utilised and we expect to see >98% compliance. Conclusions TTS is now incorporated as routine patient care for all trauma admissions >60. Compliance will be re-audited; aiming to reduce the opportunity for missed injury morbidity.

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Stenting for Large Bowel Obstruction – Evolution of a Service in a District General Hospital

Annals of The Royal College of Surgeons of England ◽

10.1308/003588409x359015 ◽

2009 ◽

Vol 91 (1) ◽

pp. 55-58 ◽

Cited By ~ 6

Author(s):

BO Olubaniyi ◽

CD McFaul ◽

VSK Yip ◽

G Abbott ◽

M Johnson

Keyword(s):

Success Rate ◽

General Hospital ◽

Large Bowel ◽

Clinical Success ◽

Clinical Success Rate ◽

District General Hospital ◽

Morbidity And Mortality ◽

Metal Stents ◽

Bridge To Surgery ◽

Colonic Stenting

INTRODUCTION Stenting for obstructing large bowel malignancy is a technique that is gradually increasing in popularity. The two main indications are for palliation and as a ‘bridge to surgery’. Some of the proposed advantages of colonic stenting are safety, reduced morbidity and mortality, avoidance of a stoma and shorter hospital stay. PATIENTS AND METHODS This was a retrospective study of consecutive patients who had self-expanding metal stents deployed between February 2001 and June 2006. Data were collected from the MEDITECH electronic integrated healthcare information support system and case note review. Data concerning demographics, primary diagnosis, and location of malignant stricture, indication for stenting, method of stenting, outcome, complications and mortality rates were obtained and analysed on Microsoft Excel. RESULTS Colonic stenting was first performed in the Countess of Chester Hospital in 2001. Thirty-two procedures have been performed since then. The median age was 80 years and the majority of cases were palliative (28 of 32), with three of the remaining cases successfully stented as a ‘bridge to surgery’. Initially, this was performed as a radiological procedure; however, the success rate was noted to be better if a surgical endoscopist was also involved. We recorded a 57% clinical success rate in the group of patients that had the colonic stent inserted radiologically; however, the group where this was inserted as a combined radiological and endoscopic procedure yielded a clinical success rate of 78%. We experienced stent-migration in four patients (13%) and rectal perforation in one patient (3%). There was no tumour re-obstruction or stent-related mortality. CONCLUSIONS A colonic stenting service can be introduced into a district general hospital with low morbidity and mortality. A well-motivated team is required and combined endoscopic and radiological approach in our hands appears to offer the best results.

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