Broughton Katherine J, Aldridge Oscar, Pradhan Sharin, Aitken R James
Department of General Surgery, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.
Department of General Surgery, Fiona Stanley Hospital, Perth, Western Australia, Australia.
ANZ J Surg. 2017 Nov;87(11):893-897. doi: 10.1111/ans.14208. Epub 2017 Aug 23.
Emergency laparotomies (ELs) are associated with high mortality and substantial outcome variation. There is no prospective Australian data on ELs. The aim of this study was to audit outcome after ELs in Western Australia.
A 12-week prospective audit was completed in 10 hospitals. Data collected included patient demographics, the clinical pathway, preoperative risk assessment and outcomes including 30-day mortality and length of stay.
Data were recorded for 198 (76.2%) of 260 patients. The 30-day mortality was 6.5% (17/260) in participating hospitals, and 5.4% (19 of 354) across Western Australia. There was minimal variation between the three tertiary hospitals undertaking 220 of 354 (62.1%) ELs. The median and mean post-operative lengths of stay, excluding patients who died, were 8 and 10 days, respectively. In the 48 patients with a prospectively documented risk of ≥10%, both a consultant surgeon and anaesthetist were present for 68.8%, 62.8% were admitted to critical care and 45.8% commenced surgery within 2 h. The mortality in those retrospectively (62; 31%) and prospectively risk-assessed was 9.5% and 5.2%, respectively.
This prospective EL audit demonstrated low 30-day mortality with little inter-hospital variation. Individual hospitals have scope to improve their standards of care. The importance of prospective risk assessment is clear.
急诊剖腹手术（ELs）与高死亡率及显著的结果差异相关。澳大利亚尚无关于急诊剖腹手术的前瞻性数据。本研究旨在审核西澳大利亚州急诊剖腹手术后的结果。
在10家医院完成了一项为期12周的前瞻性审核。收集的数据包括患者人口统计学信息、临床路径、术前风险评估以及包括30天死亡率和住院时间在内的结果。
260例患者中的198例（76.2%）记录了数据。参与研究的医院中30天死亡率为6.5%（17/260），西澳大利亚州总体为5.4%（354例中的19例）。进行了354例（62.1%）急诊剖腹手术中的220例的三家三级医院之间差异极小。排除死亡患者后，术后住院时间的中位数和均值分别为8天和10天。在48例前瞻性记录风险≥10%的患者中，68.8%有外科顾问医生和麻醉师在场，62.8%入住重症监护病房，45.8%在2小时内开始手术。回顾性（62例；31%）和前瞻性风险评估患者的死亡率分别为9.5%和5.2%。
这项前瞻性急诊剖腹手术审核显示30天死亡率低，医院间差异小。个别医院有提高护理标准的空间。前瞻性风险评估的重要性显而易见。
