The Perth Emergency Laparotomy Audit.

BACKGROUND

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.

METHODS

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.

RESULTS

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.

CONCLUSION

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.