Trompetas Vasileios, Sandison Andrew, Saunders Mike, Gurjar Shashank
Department of General Surgery, Eastbourne District General Hospital, Kings Drive, Eastbourne, UK.
Int J Surg. 2009 Feb;7(1):28-30. doi: 10.1016/j.ijsu.2008.10.001. Epub 2008 Oct 10.
In response to the recommendations of the National Confidential Enquiries into Perioperative Deaths many UK hospitals have introduced a half day (morning or afternoon) planned list for emergencies. We have compared two district general hospitals (DGH A and DGH B) within the same Trust with an afternoon and a morning list, respectively, and examine whether there is any effect on the emergency and urgent laparotomy workload.
We conducted a retrospective comparative audit of emergency and urgent laparotomies performed in a six-month period at the two hospitals. The chi-square test was used for statistical analysis.
In DGH A and DGH B, 79 and 73 laparotomies were performed, with 18% and 22% mortality, respectively, (p=0.609). The median age was 74 (18-93) years and 67 (12-92) years and the median postoperative stay was 12 (1-149) days and 14 (4-74) days, respectively. 59 laparotomies were performed during weekdays in DGH A and 51 in DGH B. There was no difference between hospitals in the seniority of the operating surgeon or the level of supervision. DGH A accommodated 24% of its laparotomies on the afternoon emergency list, 39% on elective lists, 29% in the evening, and 8% at night. DGH B accommodated 33% of its laparotomies on the morning emergency list, 8% on elective lists (p=0.001), 51% in the evening (p=0.063), and 8% at night. Overall 63% of laparotomies in DGH A and 41% in DGH B were done during daytime.
Less than one-third of laparotomies were performed on the emergency list, suggesting underutilisation. The seniority of the surgeon and the level of supervision were similar at both sites. Neither morning nor afternoon proved better in terms of service provision or training opportunities. By accommodating laparotomies onto an elective list DGH A reduced the number of laparotomies performed in the evening.
为响应全国围手术期死亡保密调查的建议，许多英国医院推出了半天（上午或下午）的急诊计划手术安排。我们比较了同一医疗信托基金内的两家地区综合医院（A区综合医院和B区综合医院），分别采用下午和上午的手术安排，并研究这是否会对急诊和紧急剖腹手术工作量产生影响。
我们对两家医院在六个月期间进行的急诊和紧急剖腹手术进行了回顾性比较审计。采用卡方检验进行统计分析。
在A区综合医院和B区综合医院，分别进行了79例和73例剖腹手术，死亡率分别为18%和22%（p=0.609）。中位年龄分别为74岁（18 - 93岁）和67岁（12 - 92岁），中位术后住院时间分别为12天（1 - 149天）和14天（4 - 74天）。A区综合医院在工作日进行了59例剖腹手术，B区综合医院进行了51例。两家医院在主刀医生的资历或监督水平方面没有差异。A区综合医院24%的剖腹手术安排在下午急诊名单上，39%在择期手术名单上，29%在晚上，8%在夜间。B区综合医院33%的剖腹手术安排在上午急诊名单上，8%在择期手术名单上（p=0.001），51%在晚上（p=0.063），8%在夜间。总体而言，A区综合医院63%的剖腹手术和B区综合医院41%的剖腹手术在白天进行。
不到三分之一的剖腹手术安排在急诊名单上，表明利用不足。两个地点的外科医生资历和监督水平相似。就服务提供或培训机会而言，上午和下午都没有表现得更好。通过将剖腹手术安排在择期手术名单上，A区综合医院减少了晚上进行的剖腹手术数量。
