Perioperative emergency laparotomy pathway for patients undergoing emergency laparotomy: A propensity score matched study.
10.47102/annals-acadmedsg.2024311
- Author:
Joel Wen Liang LAU
1
;
Janardhan BALIGA
1
;
Faheem KHAN
1
;
Ying Xin TEO
1
;
Jonathan Ming Jie YEO
2
;
Vincent Zhiwei YEOW
2
;
Christine Xia WU
2
;
Stephanie TEO
3
;
Tracy Jia Hui GOH
4
;
Philip IAU
1
Author Information
1. Department of Surgery, Ng Teng Fong General Hospital, Singapore.
2. Health Services Research & Analytics, Ng Teng Fong General Hospital, Singapore.
3. Office of Chairman Medical Board, Ng Teng Fong General Hospital, Singapore.
4. Clinical Research, Ng Teng Fong General Hospital, Singapore.
- Collective Name:Emergency Laparotomy Group
- Publication Type:Journal Article
- Keywords:
emergency medicine;
general surgery;
laparotomy;
perioperative care;
short-term outcomes
- MeSH:
Humans;
Laparotomy/methods*;
Propensity Score;
Female;
Male;
Prospective Studies;
Length of Stay/statistics & numerical data*;
Middle Aged;
Hospital Costs/statistics & numerical data*;
Postoperative Complications/epidemiology*;
Aged;
Emergencies;
Perioperative Care/methods*;
Critical Pathways;
Singapore;
Adult
- From:Annals of the Academy of Medicine, Singapore
2024;53(12):713-723
- CountrySingapore
- Language:English
-
Abstract:
INTRODUCTION:Emergency laparotomy (EL) is associated with high morbidity and mortality, often exceeding 10%. This study evaluated the impact of the EMergency Laparotomy Audit (EMLA) interdisciplinary perioperative pathway on patient outcomes, hospital costs and length of stay (LOS) within a single centre.
METHOD:A prospective cohort study was conducted from August 2020 to July 2023. The intervention team included specialist clinicians, hospital administrators and an in-hospital quality improvement team. Patients who underwent EL were divided into a pre-intervention control group (n=136) and a post-intervention group (n=293), and an 8-item bundle was implemented. Propensity scoring with a 1:1 matching method was utilised to reduce confounding and selection bias. The primary outcomes examined were LOS, hospitalis-ation costs and surgical morbidity, while secondary outcomes included 30-day mortality and adherence to the intervention protocol.
RESULTS:The utilisation of the EMLA perioperative care bundle led to a significant reduction in surgical complications (34.8% to 20.6%, P<0.01), a decrease in LOS by 3.3 days (15.4 to 12.1 days, P=0.03) and lower hospitalisation costs (SGD 40,160 to 30,948, P=0.04). Compliance with key interventions also showed improvement. However, there was no difference in 30-day mortality.
CONCLUSION:This study offers insights on how surgical units can implement systemic perioperative changes to improve outcomes for patients undergoing emergency laparotomy.
