1156 NELA – Time to Antibiotics

Abstract Introduction Early administration of antibiotics is vital in patients that have intra-abdominal sepsis. The National Emergency Laparotomy Audit (NELA) 2019 found only 19% of patients with suspected sepsis received antibiotics in the first hour. The aim of this project was to audit the current time to antibiotics in patients who underwent an emergency laparotomy in our District General Hospital (DGH) in Wales. Method This was a retrospective audit of all patients that underwent an emergency laparotomy between January to July 2019. Data was collected from the NELA database and Clinical Notes. Results 33 patients underwent an emergency laparotomy, 2 patients were excluded leaving a total of 31 patients. 55% of patients received antibiotics prior to theatre. 61% of patients triggered the systemic inflammatory response syndrome (SIRS) criteria on admission but only 47% of these patients received antibiotics. Of those that received antibiotics only 16% had them prescribed within 1 hour of arriving to the hospital. 41% of patients waited over an hour from the antibiotics being prescribed to receiving them and 1 patient did not receive the antibiotics at all. Conclusions This project shows there are many areas for improvement. Although antibiotics maybe prescribed, clear communication with nursing staff is important, so that they can be given in a timely manner. It is also important simple measures, like working cannulas, do not prevent administration of antibiotics. Re-audit of these results is vital after education. Some patients may not require antibiotics – but missing those that do could cost lives!

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670 Documentation and Communication of National Emergency Laparotomy Audit (NELA) Mortality and Morbidity Scoring with Patients Prior To Consenting: Are We Following the Best Practice?

British Journal of Surgery ◽

10.1093/bjs/znab259.086 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

M Barghash ◽

J Rehman ◽

F Salimi ◽

M Mansour

Keyword(s):

Best Practice ◽

District General Hospital ◽

Management Plan ◽

Emergency Laparotomy ◽

Mortality And Morbidity ◽

Retrospective Audit ◽

Risk Of Mortality ◽

The Uk ◽

National Emergency ◽

Management Alternatives

Abstract Aim Patients presenting as an emergency have a greater risk of dying than those admitted electively. The ability to stratify risk and calculate a percentage chance of death, not only gives the clinical team a common language to be able to formulate a management plan but also enables them to communicate this with patients and their families. This includes a full explanation of potential risks, benefits, a ceiling of care and management alternatives. In this project, we assessed if the NELA score has been properly calculated, documented prior to surgery for every emergency laparotomy patient and whether such patients were aware of NELA risk predictions prior to consenting. Method This was a retrospective audit based on the NELA guidelines of pre-operative risk stratification and the fifth report NELA recommendations. We assessed 50 case notes of patients who had laparotomies from January 2019 to April 2020 in a busy district general hospital in the UK. Results We noted that NELA risk prediction score was not utilised/documented in most of the patients with compliance of only 26%. We also found that, in the majority of notes, no NELA score discussion with the patient/family was documented, even with patients who had their NELA score calculated preoperatively. Compliance was only 14% in relation to this category. Conclusions A formal assessment of the risk of mortality and morbidity should be made explicit to each patient and should be recorded clearly in the consent form and medical record.

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EP.FRI.175 Outcomes from the introduction of routine Geriatrician review for General Surgical patients over 65 years old undergoing Emergency Laparotomy at a large District General Hospital

British Journal of Surgery ◽

10.1093/bjs/znab312.033 ◽

2021 ◽

Vol 108 (Supplement_7) ◽

Author(s):

Amira Shamsiddinova ◽

Joanne Kiang ◽

James Jegard ◽

Abhijit Bajracharya ◽

Rebecca Himpson ◽

...

Keyword(s):

General Hospital ◽

District General Hospital ◽

Service Development ◽

Emergency Laparotomy ◽

Medical Needs ◽

Team Working ◽

Surgical Critical Care ◽

Expected Mortality ◽

Service Data ◽

National Emergency

Abstract Aims The National Emergency Laparotomy Audit (NELA) results show that only 28.8% of all patients over 65years having emergency laparotomy had Geriatrician input. Advancing age predisposes to more complex medical needs due to a higher prevalence of co-morbidities, polypharmacy, cognitive impairment, and physiological frailty. Introduction of perioperative geriatrician input has been demonstrated to significantly reduce post-operatively mortality (national average 9.5%, rising to 20-40% in older age). We introduced a Geriatrician led liaison team with the initial aim to reduce 30-day mortality in older patients undergoing emergency laparotomy. Methods Prospective database was maintained of all eligible patients reviewed by the new service. Data on Rockwood Clinical Frailty Score (CFS), NELA risk prediction score, length of stay, mortality and complications were analysed. In this service development pilot we specifically assessed age and frailty demographics, expected mortality, and actual mortality in the cohort. Results All NELA patients 65 and over were reviewed by the service between September and December 2020, 35 in total. Median age 77 years; Median CFS 3 (range 2-6); Median NELA mortality risk 12% (range 0.9%-55.8%). Inpatient mortality was 2.9% and 30-day mortality 2.9% during this study period, compared to 18% in the previous year. Conclusion Our pilot study demonstrates that development of an embedded Geriatrician liaison service for patients undergoing emergency laparotomy is achievable in a district general hospital. Consistent with other larger scale studies we demonstrated significant mortality reduction in older adults undergoing emergency laparotomy with the new service offering enhanced inter-disciplinary Surgical, Critical Care and Geriatrician team-working.

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National emergency laparotomy audit in a district general hospital

International Journal of Surgery ◽

10.1016/j.ijsu.2018.05.231 ◽

2018 ◽

Vol 55 ◽

pp. S52

Author(s):

G. Hui Chin Lim ◽

K. McLauglin ◽

D. Elahmin ◽

M. Babiker ◽

I. Hamad ◽

...

Keyword(s):

General Hospital ◽

District General Hospital ◽

Emergency Laparotomy ◽

National Emergency

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30-day mortality of emergency laparotomy in a district general hospital: A retrospective audit

International Journal of Surgery ◽

10.1016/j.ijsu.2014.08.230 ◽

2014 ◽

Vol 12 ◽

pp. S96

Author(s):

Khawar Hashmi ◽

Jason Wong ◽

Christopher Bastionpillai ◽

Hannes Gransberg ◽

Maitham Al-Wouhayb

Keyword(s):

General Hospital ◽

District General Hospital ◽

Emergency Laparotomy ◽

Retrospective Audit

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Impact of laparoscopic approach in emergency major abdominal surgery: single-centre analysis of 748 consecutive cases

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2017.0229 ◽

2018 ◽

Vol 100 (4) ◽

pp. 279-284 ◽

Cited By ~ 7

Author(s):

PH Pucher ◽

NC Carter ◽

BC Knight ◽

SKC Toh ◽

V Tucker ◽

...

Keyword(s):

Confidence Interval ◽

Temporal Trends ◽

Laparoscopic Approach ◽

High Volume ◽

District General Hospital ◽

Outcome Data ◽

Emergency Laparotomy ◽

Improved Outcomes ◽

Intensive Care Stay ◽

National Emergency

Background Acute abdominal pathology requiring emergency laparotomy is a common surgical presentation. Despite its widespread implementation in other surgical procedures, laparoscopy, rather than laparotomy, is sparingly used in major emergency surgery. This study reports outcomes and impact of rising use of laparoscopy for a single high-volume district general hospital. Methods Data were retrieved from the prospective National Emergency Laparotomy Audit database for a 30-month period. Patient, procedural, and in-hospital outcome data were collated. Temporal trends were assessed and regression analysis conducted for clinical outcomes. Results A total of 748 consecutive cases were recorded. There was an increasing use of laparoscopy over the study period, with 49% of cases attempted laparoscopically in the final six-month interval. Patients treated laparoscopically were at reduced risk of mortality (odds ratio 0.114, 95% confidence interval 0.024 to 0.550) and experienced reduced length of intensive care stay (regression coefficient –1.571, 95% confidence interval –2.625 to –0.517) in multivariate adjusted analysis. Conclusions Laparoscopy is safe and feasible in a large proportion of cases. It is associated with improved outcomes versus laparotomy.

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672 Emergency Laparotomy Patients: Is the Current Local Consent Process Compliant with Local and National Guidelines?

British Journal of Surgery ◽

10.1093/bjs/znab259.087 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

M Barghash ◽

J Rehman ◽

F Salimi ◽

M Mansour

Keyword(s):

District General Hospital ◽

The Other ◽

Emergency Laparotomy ◽

National Guidelines ◽

Consent Forms ◽

Surgical Practice ◽

Patient Demographics ◽

Retrospective Audit ◽

Valid Consent ◽

The Uk

Abstract Aim Obtaining valid consent is crucial to patient care. It also minimises the chance for claims regarding legal action for battery, breach of human rights and/or successful clinical negligence claims. In this project, we assessed whether a documented discussion took place prior to signing consent forms and whether consent forms were being completed adequately. Method This was a retrospective audit based on the Royal College of Surgeons’ (Good Surgical Practice) guidelines and the local trust policy. We assessed 50 case notes of patients who had a laparotomy from January 2019 to April 2020 in a busy district general hospital in the UK. Results We noted that our practice was fully compliant with documenting patient demographics, signatures, and the name of the procedure in consent forms. On the other hand, we found that, in the majority of cases there was no documentation of detailed benefits, risks, alternatives of surgery in case notes where compliance was only 21%. In addition, poor compliance was noted in documenting some of the possible risks e.g., hernia (50% compliance), leak (46% compliance) and ileus (26% compliance). Conclusions A detailed discussion with the patient and family including benefits, risks and alternatives of surgery should take place and this should be documented clearly in the case notes prior to signing the consent form.

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SP3.2.3 The open abdomen is associated with increased morbidity and mortality after emergency laparotomy: a retrospective cohort study

British Journal of Surgery ◽

10.1093/bjs/znab361.070 ◽

2021 ◽

Vol 108 (Supplement_7) ◽

Author(s):

Charlotte Harrison ◽

Charles Beresford ◽

Tania Magro ◽

Spyros Marinos ◽

Rame Sunthareswaran ◽

...

Keyword(s):

Length Of Stay ◽

Primary Closure ◽

Open Abdomen ◽

District General Hospital ◽

Abdominal Sepsis ◽

Morbidity And Mortality ◽

Emergency Laparotomy ◽

Retrospective Case ◽

Operative Outcomes ◽

Hospital Patients

Abstract Aims The open abdomen following emergency laparotomy for peritoneal contamination is becoming an increasingly popular method of managing severe intra-abdominal sepsis. However, this approach has been associated with increased morbidity and mortality. The aim of this study is to compare patient populations and post-operative outcomes from patients undergoing primary closure or those managed with an open abdomen after emergency laparotomy. Methods A retrospective case note review was undertaken of all patients recorded on the NELA database over a five-year period at a district general hospital. Patients with no intra-abdominal contamination or who were palliated peri-operatively were excluded. Data collected included P-possum morbidity and mortality, post-operative complications (Clavien-Dindo), length of stay and in-hospital mortality. Results 811 NELA entries were reviewed; 313 were included with 79% (n = 248) undergoing primary closure. Cohorts were similar in age and sex. P-possum morbidity and mortality scores were significantly higher in the open abdomen group (89% vs 79%, p = 0.0003; 38% vs 24%, p = 0.0003, respectively). Of the outcome variables, significant complications (34% vs 11%, p = 0.001), length of stay (31 vs 18 days, p = 0.0001) and mortality (11% vs 4%, p = 0.001) were significantly higher in the open compared to closed abdomen group. Only 10% of patients undergoing primary closure required further surgery. Conclusions This study highlights that the open abdomen is used in higher risk patients, with significantly poorer outcomes. This approach, which confers a significant physiological burden requiring further intervention should be used with caution in selected cases.

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