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.
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

Lymphatic malformations (LMs) are one of the more commonly encountered cystic head-and-neck tumors. Surgical excision is the traditional treatment with inherent perioperative risks. Alternative treatment of these tumors using percutaneous sclerotherapy agents has been proposed with no major consensus on the treatment approaches and sclerotherapy agent choices. This paper presents a systematic review of percutaneous ethanol sclerotherapy for neck lymphangioma and a case report of ethanol ablation in a patient with neck lymphangioma with good cosmesis results. Systematic review was conducted on PubMed using key words: “Ethanol” OR “Alcohol” AND “Ablation” OR “Sclerotherapy” OR “Sclerosing” AND “Lymphangioma” OR “Lymphatic Malformation” as per Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. Three hundred fifteen articles from initial PubMed search results were screened by titles and abstracts. Full text was retrieved. 3 studies were included in our systematic review. Overall evidence quality is modest with marked heterogeneity. All 12 patients treated with percutaneous ethanol sclerotherapy for head-and-neck LMs reported favorable response. Only 1 patient (8.3%) encountered a peri-procedural complication. Percutaneous ethanol sclerotherapy of neck lymphangioma in our patient also reported favorable response with no complications. Invasive treatment for LMs should be personalized and dependent on the availability of experienced operators/ centers with appropriate volume in either primary excisional surgery or percutaneous sclerotherapy. Percutaneous ethanol sclerotherapy is an acceptable option with benefits of widespread availability and cost-effectiveness in our South-East Asia region. Limitations of our review are largely due to significant study heterogeneity.