Department of Anaesthesia, Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust, Queen Victoria Road, Newcastle upon Tyne NE1 4LP, UK.
Br J Anaesth. 2012 Sep;109(3):368-75. doi: 10.1093/bja/aes165. Epub 2012 Jun 22.
Emergency laparotomy is a common intra-abdominal procedure. Outcomes are generally recognized to be poor, but there is a paucity of hard UK data, and reports have mainly been confined to single-centre studies.
Clinicians were invited to join an 'Emergency Laparotomy Network' and to collect prospective non-risk-adjusted outcome data from a large number of NHS Trusts providing emergency surgical care. Data concerning what were considered to be key aspects of perioperative care, including thirty-day mortality, were collected over a 3 month period.
Data from 1853 patients were collected from 35 NHS hospitals. The unadjusted 30 day mortality was 14.9% for all patients and 24.4% in patients aged 80 or over. There was a wide variation between units in terms of the proportion of cases subject to key interventions that may affect outcomes. The presence of a consultant surgeon in theatre varied between 40.6% and 100% of cases, while a consultant anaesthetist was present in theatre for 25-100% of cases. Goal-directed fluid management was used in 0-63% of cases. Between 0% and 68.9% of the patients returned to the ward (level one) after surgery, and between 9.7% and 87.5% were admitted to intensive care (level three). Mortality rates varied from 3.6% to 41.7%.
This study confirms that emergency laparotomy in the UK carries a high mortality. The variation in clinical management and outcomes indicates the need for a national quality improvement programme.
急诊剖腹手术是一种常见的腹腔内手术。一般认为手术结果不佳，但英国缺乏硬数据，且报告主要局限于单中心研究。
邀请临床医生加入“急诊剖腹手术网络”，并从提供急诊外科护理的多家 NHS 信托机构收集大量非风险调整的预后数据。在三个月的时间内，收集了被认为是围手术期护理关键方面的数据，包括 30 天死亡率。
从 35 家 NHS 医院收集了 1853 名患者的数据。所有患者的未调整 30 天死亡率为 14.9%，80 岁及以上患者的死亡率为 24.4%。各单位之间接受可能影响预后的关键干预措施的病例比例存在很大差异。手术室内顾问外科医生的存在率在 40.6%至 100%之间，而顾问麻醉师在手术室内的存在率为 25%-100%。目标导向的液体管理在 0-63%的病例中使用。手术后，有 0-68.9%的患者返回病房（一级），9.7%-87.5%的患者被收入重症监护病房（三级）。死亡率从 3.6%到 41.7%不等。
本研究证实英国的急诊剖腹手术死亡率较高。临床管理和结果的差异表明需要制定国家质量改进计划。
