使用改良的 NELA 工具格式对创伤性和非创伤性急诊剖腹手术的结果进行比较分析。

Comparative outcome analysis of trauma and non-trauma emergency laparotomy using a modified NELA tool format.

机构信息

Department of Surgery, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, South Africa and Department of General Surgery, Ngwelezana Hospital, South Africa.

Department of Surgery, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, South Africa and Faurie, Skinner and Partners Inc., Busamed Hillcrest Private Hospital, South Africa.

出版信息

S Afr J Surg. 2021 Mar;59(1):12-19.

PMID:33779099

Abstract

BACKGROUND

Emergency laparotomy (EL) encompasses a diverse range of procedures that general surgeons commonly perform for both trauma and non-trauma related conditions in South Africa (SA). Despite differences in the underlying pathology and influence of the surgical procedure, these patients share one care pathway for preoperative, operative and postoperative care. This study reviewed patients undergoing trauma EL and non-trauma EL in a general surgery setting at a rural KwaZulu-Natal tertiary hospital to compare results between the groups using a modified National Emergency Laparotomy Audit (NELA) tool format.

METHODS

Consecutive adult patients undergoing midline EL at Ngwelezana Hospital between 1 March and 31 May 2018 were included. Patient factors analysed were demographic data (age, gender) and risk factors: National Confidential Enquiry into Perioperative Deaths (NCEPOD) grade, American Society of Anesthesiologists (ASA) grade, and comorbidity. Process of care factors included grade of the physician, time to surgery, time of surgery and duration of surgery. The primary outcome measure was mortality. Secondary outcome measures were intensive care unit (ICU) admissions, complications, and length of stay (LOS) > 14 days.

RESULTS

The study included 110 participants who met the inclusion criteria representing a total of 174 laparotomies. The trauma EL group had lower ASA grades ( = 0.003), less comorbidities ( = 0.002), more often went to theatre within six hours (42/56; 75.0%) ( < 0.001), more admissions to ICU (23/56; 41.1%) ( < 0.001), more complications (29/56; 51.8%) ( = 0.039), and higher length of stay > 14 days (16/56; 28.6%) ( = 0.037).

CONCLUSION

The trauma EL group represents a high-risk group for morbidity and mortality at Ngwelezana Hospital.

摘要

背景

在南非，普通外科医生通常会进行各种不同的急诊剖腹手术（EL），包括创伤和非创伤相关的疾病。尽管患者的基础病理和手术程序存在差异，但这些患者在术前、术中和术后护理方面都遵循同一条护理路径。本研究回顾了在夸祖鲁-纳塔尔省一家农村三级医院的普通外科环境中接受创伤性 EL 和非创伤性 EL 的患者，使用改良的国家急诊剖腹手术审核（NELA）工具格式比较两组患者的结果。

方法

连续纳入 2018 年 3 月 1 日至 5 月 31 日期间在 Ngwelezana 医院接受中线 EL 的成年患者。分析的患者因素包括人口统计学数据（年龄、性别）和风险因素：国家围手术期死亡机密调查（NCEPOD）等级、美国麻醉师协会（ASA）等级和合并症。护理过程因素包括医生的级别、手术时间、手术时间和手术持续时间。主要结局指标是死亡率。次要结局指标包括重症监护病房（ICU）入院、并发症和住院时间（LOS）>14 天。

结果

该研究共纳入了 110 名符合纳入标准的患者，共进行了 174 例剖腹手术。创伤性 EL 组的 ASA 分级较低（=0.003），合并症较少（=0.002），更常在 6 小时内进入手术室（42/56；75.0%）（<0.001），更多 ICU 入院（23/56；41.1%）（<0.001），更多并发症（29/56；51.8%）（=0.039），和 LOS>14 天的比例更高（16/56；28.6%）（=0.037）。