Standardised mortality by post-operative location in the National Emergency Laparotomy Audit

2017 ◽  
Author(s):  
Merle Cohen
Keyword(s):  
Emergency Laparotomy ◽  
National Emergency

scholarly journals Short-term outcomes after emergency surgery for complicated peptic ulcer disease from the UK National Emergency Laparotomy Audit: a cohort study

BMJ Open ◽  
2018 ◽  
Vol 8 (8) ◽  
pp. e023721 ◽  
Author(s):  
Benjamin E Byrne ◽  
Michael Bassett ◽  
Chris A Rogers ◽  
Iain D Anderson ◽  
Ian Beckingham ◽  
...  
Keyword(s):  
Peptic Ulcer ◽  
Cohort Study ◽  
Peptic Ulcer Disease ◽  
Fatal Outcome ◽  
Mortality Rates ◽  
Emergency Laparotomy ◽  
Ulcer Disease ◽  
Factors Associated ◽  
Institutional Volume ◽  
National Emergency

ObjectivesThis study used national audit data to describe current management and outcomes of patients undergoing surgery for complications of peptic ulcer disease (PUD), including perforation and bleeding. It was also planned to explore factors associated with fatal outcome after surgery for perforated ulcers. These analyses were designed to provide a thorough understanding of current practice and identify potentially modifiable factors associated with outcome as targets for future quality improvement.DesignNational cohort study using National Emergency Laparotomy Audit (NELA) data.SettingEnglish and Welsh hospitals within the National Health Service.ParticipantsAdult patients admitted as an emergency with perforated or bleeding PUD between December 2013 and November 2015.InterventionsLaparotomy for bleeding or perforated peptic ulcer.Primary and secondary outcome measuresThe primary outcome was 60-day in-hospital mortality. Secondary outcomes included length of postoperative stay, readmission and reoperation rate.Results2444 and 382 procedures were performed for perforated and bleeding ulcers, respectively. In-hospital 60-day mortality rates were 287/2444 (11.7%, 95% CI 10.5% to 13.1%) for perforations, and 68/382 (17.8%, 95% CI 14.1% to 22.0%) for bleeding. Median (IQR) 2-year institutional volume was 12 (7–17) and 2 (1–3) for perforation and bleeding, respectively. In the exploratory analysis, age, American Society of Anesthesiology score and preoperative systolic blood pressure were associated with mortality, with no association with time from admission to operation, surgeon grade or operative approach.ConclusionsPatients undergoing surgery for complicated PUD face a high 60-day mortality risk. Exploratory analyses suggested fatal outcome was primarily associated with patient rather than provider care factors. Therefore, it may be challenging to reduce mortality rates further. NELA data provide important benchmarking for patient consent and has highlighted low institutional volume and high mortality rates after surgery for bleeding peptic ulcers as a target for future research and improvement.

scholarly journals 61 Impact of Dedicated Geriatrician Involvement on National Emergency Laparotomy Audit Standards and Outcomes

2019 ◽  
Vol 48 (Supplement_3) ◽  
pp. iii1-iii16
Author(s):  
Roisin Coary ◽  
Kath Jenkins ◽  
Emma Mitchell ◽  
Anne Pullyblank ◽  
David Shipway
Keyword(s):  
Older Patients ◽  
Ad Hoc ◽  
Gastrointestinal Surgery ◽  
Emergency Laparotomy ◽  
Published Data ◽  
Mortality And Morbidity ◽  
The United Kingdom ◽  
Service Introduction ◽  
National Emergency ◽  
The Impact

Abstract Background Older patients undergoing emergency laparotomy (EmLap) have high levels of mortality and morbidity. The National Emergency Laparotomy Audit (NELA) in the United Kingdom records processes and outcome measures for patients undergoing EmLap. Recent data shows that geriatrician review is associated with reduced post-surgical mortality (Oliver C.M. et al., British Journal of Anaesthesia 2018). Geriatrician review of all patients aged ≥70 years is a NELA standard. However, the most recent national report shows only 23% compliance, falling short of the target of 80% and consistently the poorest performing standard. Methods In August 2018, we established a dedicated gastrointestinal surgery liaison service to replace ad hoc geriatrician reviews. We evaluated the impact on NELA standard compliance and patient outcomes. Data were extracted from the local NELA database on all patients aged ≥70 years, for the first six months of the service (September to February). These were compared to the same time period in the preceding year prior to service launch. Results Following service introduction, increased numbers of patients aged ≥70 years underwent EmLap: 50 (2018-9) vs 31 (2017-8). Geriatrician review occurred in 86% (n=43) in 2018-9, compared to 16% (n=5) in 2017-8. Inpatient mortality fell from 23% (n=7) in 2017-8 to 14% (n=7) in 2018-9. Discharge to own home rose to 76% (n=38) in 2018-9 from 68% (n=21) in 2017-8. One patient in each cohort was newly discharged to a nursing home. Mean length of stay was 17.9 days in 2018-9 (range 3-75), versus 17.6 in 2017-8 (range 3-94). Conclusion Introduction of a dedicated geriatric surgical liaison service is associated with increased compliance with NELA standards. Despite more emergency laparotomies being performed on older patients, this was associated with improved mortality and rates of home discharge, consistent with published data. Targeted investment in surgical liaison services may therefore be warranted.

scholarly journals Defining the older patient population that require, but do not undergo emergency laparotomy: an observational cohort study protocol

2021 ◽  
Author(s):  
Nicola Reeves ◽  
Susan Chandler ◽  
Elizabeth McLennan ◽  
Angeline Price ◽  
Jemma Boyle ◽  
...  
Keyword(s):  
Older Adults ◽  
Decision Making ◽  
Cohort Study ◽  
Emergency Laparotomy ◽  
Ageing Population ◽  
Older Patient ◽  
Vulnerable Patient ◽  
The Uk ◽  
National Emergency ◽  
Vulnerable Patient Group

<p><strong>Background: </strong>Despite older adults (65 years and above) accounting for almost half of emergency laparotomies and an ageing population, there remains a paucity of research in the older adult emergency surgery population. One key clinical area that requires urgent assessment is the older patient who presents with acute abdominal pathology treatable by laparotomy, but who does not undergo surgery (NoLAP). <strong></strong></p><p><strong>Methods: </strong>This multicentre prospective cohort study [defining the denominator: emergency laparotomy and frailty study 2 (ELF2)] will recruit consecutive older adults that require but do not undergo emergency laparotomy (NoLAP). We will recruit from 47 national health service hospitals over a 3-month timeframe. The same criteria as NELA for inclusion and exclusion will be applied. The primary aim is 90-day mortality. Secondary aims include characterisation of the NoLAP group, frailty and sarcopenia with comparison to those older adults that have undergone emergency laparotomy (ELAP). Decision-making will also be explored. Assuming a NoLAP rate of 32% and 10% dropout, a minimum of 700 patients are required for 95% power (alpha=0.05).</p><p><strong>Conclusions: </strong>The UK national emergency laparotomy audit has provided vital information on those patients undergoing emergency laparotomy and driven standards in operative and perioperative care. However, little is known of outcomes in those patients who do not undergo emergency laparotomy.  Improved understanding of this NoLAP population would aid shared decision-making and improve standards for this otherwise poorly understood vulnerable patient group.</p><p><strong>Trial registration:</strong> This study is registered online at www.clinicaltrial.gov (Reg number: ISRCTN14556210).</p><p><strong> </strong></p>

scholarly journals EP.FRI.974 NELA 30 day mortality: A single centre experience

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
M A Gok ◽  
O Shams ◽  
F Ftaieh ◽  
U A Khan
Keyword(s):  
High Risk ◽  
Survival Curve ◽  
Emergency Laparotomy ◽  
Single Centre ◽  
High Risk Patients ◽  
Single Centre Experience ◽  
Risk Patients ◽  
The Uk ◽  
National Emergency

Abstract Aims National emergency laparotomy audit (NELA) developed in 2014 in the UK, aims to improve of quality of care of patients undergoing emergency laparotomy. NELA highlights the importance of identifying high risk patients for potential significant morbidity and mortality. The aim of this study is to review the NELA 30 day mortality at a single centre. Methods This is a retrospective review of all 30 day NELA mortality patients since 2014 carried out at East Cheshire NHS Trust until January 2020. The NELA survivors beyond 30 days were used as controls. Results Conclusion The overall NELA 30 day mortality rate was 9.8 %. NELA deaths occurred in the older, frail, multi-comorbid & high ASA status patients. Most NELA deaths occur within 90 days, whereas patient survival curve appears to plateau out beyond 90 days. P possum can be used to identify high risk patients, where early collaborative senior assessment by consultant surgeons, anaesthetists and intensivists may identify and allocate appropriate surgical intervention. 

scholarly journals 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

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.

scholarly journals Organisational factors and mortality after an emergency laparotomy: multilevel analysis of 39 903 National Emergency Laparotomy Audit patients

2018 ◽  
Vol 121 (6) ◽  
pp. 1346-1356 ◽  
Author(s):  
C.M. Oliver ◽  
M.G. Bassett ◽  
T.E. Poulton ◽  
I.D. Anderson ◽  
D.M. Murray ◽  
...  
Keyword(s):  
Multilevel Analysis ◽  
Emergency Laparotomy ◽  
National Emergency ◽  
Organisational Factors

scholarly journals 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?

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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