Eighth patient report – emergency laparotomy (NELA)
The NELA team published an addendum to the Eighth Annual Report in January 2024 (for 1 Dec 2020 – 30 Nov 2021 data), which includes information on case ascertainment for English hospitals, as well as 30-day risk-adjusted mortality.
Based on data from 22,132 patients who had emergency bowel surgery in England and Wales between December 2020 and November 2021, this report from the National Emergency Laparotomy Audit (NELA) found that improvements in in-hospital mortality have levelled off (9.2% in year 8 compared to 9.1% and 9.6% in years 7 and 6 respectively). As such, it calls for hospitals to continue to engage with NELA data collection and, in particular, to make use of real-time data and resources available to drive clinical and service quality improvement.
In addition, the report found that there has been improvement in various aspects of care around emergency laparotomy, such as direct consultant delivered care in theatre and length of postoperative hospital stay. But states that specific concerns remain around delays in pathways of care for many patients between time of arrival in hospital and definitive surgical intervention (‘door-to-surgery time’). More specific key messages include:
- Patients experienced long delays from time of arrival at hospital to time of surgery, including those with sepsis suspected at arrival in hospital (median 15.6 hours to theatre)
- Many patients (77.7%) with suspected sepsis on arrival did not receive antibiotics within an hour of arrival in hospital
- One in five high-risk patients did not receive postoperative care in a critical care unit.
The report also found that frailty doubled the risk of mortality of patients aged 65 and over (13.0% vs 5.9%), but review by a member of the elderly care team was associated with a significant reduction in mortality (5.9% vs 9.5% amongst non-frail patients, and 13.0% vs 22.3% amongst frail patients). However, this is not routine practice in many hospitals.
Read the full report: You can see all key findings and read the report in full by clicking on the link below.
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