TY - JOUR
T1 - Improving outcomes of emergency bowel surgery using NELA model
AU - Sultan, Rizwan
AU - Zafar, Hasnain
N1 - Funding Information:
National Emergency Laparotomy Audit (NELA), funded by NHS England and Welsh Government, was commissioned
PY - 2018/2/1
Y1 - 2018/2/1
N2 - Objective: To find outcomes of emergency bowel surgery and review the processes involved in the care of these patients on the same template used in National Emergency Laparotomy Audit (NELA). Study Design: An audit. Place and Duration of Study: Surgery Department, The Aga Khan University Hospital, Karachi, from December 2013 to November 2014. Methodology: Patients undergone emergency bowel surgery during the review period were included. Demographic data, type of admission, ASA grade, urgency of surgery, P-POSSUM score, indication of surgery, length of stay and outcome was recorded. Data was then compared with the data published by NELA team in their first report. P-value for categorical variables was calculated using Chi-square tests. Results: Although the patients were younger with nearly same spectrum of disease, the mortality rate was significantly more than reported in NELA (24% versus 11%, p=0.004). Comparison showed that care at AKUH was significantly lacking in terms of proper preoperative risk assessment and documentation, case booking to operating room timing, intraoperative goal directed fluid therapy using cardiac output monitoring, postoperative intensive care for highest risk patients and review of elderly patients by MCOP specialist. Conclusion: This study helped in understanding the deficiencies in the care of patients undergoing emergency bowel surgery and alarmingly poor outcomes in a very systematic manner. In view of results of this study, it is planned to do interventions in the deficient areas to improve care given to these patients and their outcomes with the limited resources of a developing country.
AB - Objective: To find outcomes of emergency bowel surgery and review the processes involved in the care of these patients on the same template used in National Emergency Laparotomy Audit (NELA). Study Design: An audit. Place and Duration of Study: Surgery Department, The Aga Khan University Hospital, Karachi, from December 2013 to November 2014. Methodology: Patients undergone emergency bowel surgery during the review period were included. Demographic data, type of admission, ASA grade, urgency of surgery, P-POSSUM score, indication of surgery, length of stay and outcome was recorded. Data was then compared with the data published by NELA team in their first report. P-value for categorical variables was calculated using Chi-square tests. Results: Although the patients were younger with nearly same spectrum of disease, the mortality rate was significantly more than reported in NELA (24% versus 11%, p=0.004). Comparison showed that care at AKUH was significantly lacking in terms of proper preoperative risk assessment and documentation, case booking to operating room timing, intraoperative goal directed fluid therapy using cardiac output monitoring, postoperative intensive care for highest risk patients and review of elderly patients by MCOP specialist. Conclusion: This study helped in understanding the deficiencies in the care of patients undergoing emergency bowel surgery and alarmingly poor outcomes in a very systematic manner. In view of results of this study, it is planned to do interventions in the deficient areas to improve care given to these patients and their outcomes with the limited resources of a developing country.
KW - Bowel surgery
KW - Emergency laparotomy
KW - NELA model
KW - Outcome
UR - http://www.scopus.com/inward/record.url?scp=85041626466&partnerID=8YFLogxK
U2 - 10.29271/jcpsp.2018.02.150
DO - 10.29271/jcpsp.2018.02.150
M3 - Article
C2 - 29394976
AN - SCOPUS:85041626466
SN - 1022-386X
VL - 28
SP - 150
EP - 154
JO - Journal of the College of Physicians and Surgeons--Pakistan : JCPSP
JF - Journal of the College of Physicians and Surgeons--Pakistan : JCPSP
IS - 2
ER -