Cox Jason Douglas, Dunley Frank, Tian Jia, Booth Kate, Paynter Jessica, Lee Chun Hin Angus
Bendigo Health, Monash University School of Rural Health, Bendigo, Victoria, Australia.
Bendigo Health, Monash University, Bendigo, Victoria, Australia.
ANZ J Surg. 2024 Dec;94(12):2238-2244. doi: 10.1111/ans.19260. Epub 2024 Oct 28.
Routine preoperative risk assessment (RPRA) using objective risk prediction tools may improve the perioperative outcomes of emergency major abdominal surgery (EMAS). This project aims to identify whether the introduction of RPRA with the 'National Emergency Laparotomy Audit (NELA) Calculator' as standard-of-care for EMAS at a regional Victorian hospital has improved postoperative outcomes, reduced unplanned postoperative critical care unit (CCU) admission rates, and impacted the 'no-lap' rate.
An audit was performed including all adult general surgery patients who required EMAS at Bendigo Health between September 2017 and August 2022, including those palliated up-front. Patients requiring surgery for uncomplicated appendicitis, cholecystitis, trauma, and diagnostic laparoscopy were excluded. Patient demographics, preoperative NELA score, CCU admission data and postoperative outcomes were collected and compared between patients undergoing surgery before and after the introduction of RPRA.
Six hundred and ninety-one patients were included in the analysis. Median NELA score was 5 (IQR 1.5-11.75). 2.60% of patients were palliated up-front and did not proceed to surgery. Among the 673 operative patients, 30-day mortality was 5.20%. Following the introduction of RPRA there was a significant reduction in the unplanned CCU admission rate, from 9.14% to 3.48% (P = 0.04). There was no change in postoperative mortality, severe complication rate or planned CCU admission rate.
RPRA reduced rate of unplanned CCU admissions. Postoperative mortality and complication rates did not change following introduction of RPRA. RPRA appears useful in guidance of preoperative palliative decision-making, but further study is required to validate its use in this context.
使用客观风险预测工具进行常规术前风险评估（RPRA）可能会改善急诊重大腹部手术（EMAS）的围手术期结局。本项目旨在确定在维多利亚州一家地区医院引入以“国家急诊剖腹手术审计（NELA）计算器”作为EMAS标准治疗方案的RPRA是否改善了术后结局、降低了计划外术后重症监护病房（CCU）入住率，并影响了“非剖腹手术”率。
对2017年9月至2022年8月期间在本迪戈健康中心接受EMAS的所有成年普通外科患者进行审计，包括那些预先接受姑息治疗的患者。需要进行单纯阑尾炎、胆囊炎、创伤手术以及诊断性腹腔镜检查的患者被排除。收集患者的人口统计学数据、术前NELA评分、CCU入住数据和术后结局，并对引入RPRA前后接受手术的患者进行比较。
691例患者纳入分析。NELA评分中位数为5（四分位间距1.5 - 11.75）。2.60%的患者预先接受姑息治疗，未进行手术。在673例手术患者中，30天死亡率为5.20%。引入RPRA后，计划外CCU入住率显著降低，从9.14%降至3.48%（P = 0.04）。术后死亡率、严重并发症发生率或计划内CCU入住率没有变化。
RPRA降低了计划外CCU入住率。引入RPRA后，术后死亡率和并发症发生率没有变化。RPRA似乎有助于指导术前姑息决策，但需要进一步研究以验证其在此背景下的应用。
