Hewitt Joseph N, Milton Thomas J, Lee Octavia Tz-Shane, Tinnion Joshua, Barbaro Antonio, Foley Katarina, Murshed Ishraq, Georges Nick, Shukla Rippan, Main Cameron, Dobbins Christopher, Trochsler Markus I
Discipline of Surgery, The University of Adelaide, The Queen Elizabeth Hospital, South Australia, Australia.
Department of Surgery, Royal Adelaide Hospital, South Australia, Australia.
Surg Pract Sci. 2023 Nov 24;15:100225. doi: 10.1016/j.sipas.2023.100225. eCollection 2023 Dec.
Emergency laparotomy (EL) is associated with high mortality rates and is performed on a heterogenous patient population. Pre-operative risk assessment is one tool which can assist with EL patient care. We aimed to characterise rates of pre-operative risk assessment for EL patients in South Australia.
A retrospective audit of all patients undergoing EL over one year in six participating hospitals in South Australia was undertaken. Patient demographics, operation details, risk assessments (e.g. NELA, POSSUM, ACS-NSQIP) and outcomes were recorded.
422 ELs were audited. Preoperative risk assessments were recorded for 42 (10 %) operations. The 30-day mortality rate was 9 %. There was no difference in mortality rates for patients with or without a risk assessment documented. Hospital participation in the Australia and New Zealand Emergency Laparotomy Audit (ANZELA) was associated with increased rates of risk assessment. Increasing patient age and then presence of certain comorbidities were also associated with increased rates of risk assessment.
This audit shows poor uptake of recommendations for preoperative risk assessment in EL patients in South Australia. Comparable mortality rates to previously published Australian and international data are demonstrated. Factors associated with increased risk assessment rates are identified and are relevant to future quality improvement activities.
急诊剖腹手术（EL）死亡率高，且手术对象为异质性患者群体。术前风险评估是有助于急诊剖腹手术患者护理的一种工具。我们旨在描述南澳大利亚州急诊剖腹手术患者的术前风险评估率。
对南澳大利亚州六家参与研究的医院中一年内接受急诊剖腹手术的所有患者进行回顾性审计。记录患者人口统计学资料、手术细节、风险评估（如NELA、POSSUM、美国外科医师学会国家外科质量改进计划[ACS-NSQIP]）及结果。
共审计了422例急诊剖腹手术。42例（10%）手术记录了术前风险评估。30天死亡率为9%。有或没有记录风险评估的患者死亡率无差异。医院参与澳大利亚和新西兰急诊剖腹手术审计（ANZELA）与风险评估率增加相关。患者年龄增加以及某些合并症的存在也与风险评估率增加相关。
本次审计表明，南澳大利亚州急诊剖腹手术患者对术前风险评估建议的采纳情况不佳。显示出与先前发表的澳大利亚和国际数据相当的死亡率。确定了与风险评估率增加相关的因素，这些因素与未来的质量改进活动相关。
