Ong Marc Weijie, Goh Serene Si Ning, Tung Wei Min James, Lim Woan Wui, Hu Hilda Haoling, Lim Choong Yan, Ng Priscilla, Tan Kok Yang, Goo Tiong Thye Jerry
Department of General Surgery Khoo Teck Puat Hospital Singapore City Singapore.
Lee Kong Chian School of Medicine Nanyang Technological University Singapore City Singapore.
Acute Med Surg. 2021 Oct 28;8(1):e702. doi: 10.1002/ams2.702. eCollection 2021 Jan-Dec.
Emergency laparotomy (EL) is a common surgery associated with high morbidity and mortality. An enhanced care pathway incorporates evidence-based care bundles with the aim of providing standardized perioperative care. Prior to 2019, EL management in our institution was not standardized. This study aims to assess whether implementation of a transdisciplinary perioperative Emergency Laparotomy (ELAP) pathway improves clinical and efficiency outcomes of EL.
A prospective single-center audit was undertaken between 1 January and 31 December, 2019 following the implementation of the ELAP pathway. Comparisons were made with retrospective data from the preimplementation period between 1 January and 31 December, 2017. Demographics and clinical and efficiency outcomes were compared for patients (age > 16 years old) requiring EL for acute abdominal conditions.
There were 152 and 162 patients from preimplementation and postimplementation periods, respectively. There was a nonsignificant reduction of 30-day mortality in the intervention group receiving perioperative pathway care compared with the preintervention group (3.1% versus 5.3%, respectively; = 0.40). There was a decrease in postoperative complications in the intervention group, in particular for Clavien-Dindo IV complications (11.2% versus 3.1%, < 0.01). Efficiency outcomes improved postimplementation with increased consultant surgeon and anesthetist presence in operating theater and postoperative geriatric assessment for elderly patients. There was an overall reduction in cost of hospital stay from S$32,128 to $27,947 ( = 0.24).
Implementation of a transdisciplinary perioperative care pathway was associated with significant reduction in postoperative complications, improvement in 30-day mortality and efficiency outcomes at reduced hospital costs for patients following EL in our institution.
急诊剖腹手术（EL）是一种常见手术，其发病率和死亡率较高。强化护理路径纳入了循证护理包，旨在提供标准化的围手术期护理。2019年之前，我们机构的EL管理并不规范。本研究旨在评估跨学科围手术期急诊剖腹手术（ELAP）路径的实施是否能改善EL的临床和效率结果。
在ELAP路径实施后，于2019年1月1日至12月31日进行了一项前瞻性单中心审计。与2017年1月1日至12月31日实施前时期的回顾性数据进行比较。对因急性腹部疾病需要进行EL的患者（年龄>16岁）的人口统计学、临床和效率结果进行了比较。
实施前和实施后时期分别有152例和162例患者。与干预前组相比，接受围手术期路径护理的干预组30天死亡率有非显著降低（分别为3.1%和5.3%；P=0.40）。干预组术后并发症有所减少，尤其是Clavien-Dindo IV级并发症（11.2%对3.1%，P<0.01）。实施后效率结果有所改善，手术室中顾问外科医生和麻醉师的在场时间增加，老年患者术后进行了老年评估。住院费用总体从32,128新元降至27,947新元（P=0.24）。
在我们机构中，跨学科围手术期护理路径的实施与EL患者术后并发症显著减少、30天死亡率改善以及效率结果提高且住院成本降低相关。
