A session at the Annual Congress of the Association of Anaesthetists of Great Britain and Ireland (AAGBI) recently discussed data from the UK’s first national audit into emergency laparotomy surgery.
The data shows a 12-fold variation in the mortality rate from emergency laparotomy surgery between the best and the worst hospitals across the UK. “These data are shocking and may reflect the wide variation in provision of care across UK hospitals in terms of provision of essential facilities and the presence of consultant anaesthetists and surgeons that should be present to conduct these operations,” said Professor Mike Grocott, University of Southampton, UK, who is co-leading a new National Audit project with Dr Dave Murray, James Cook University Hospital, Middlesbrough, UK. The data, covering 1,853 patients, has been produced by the Emergency Laparotomy Network Volunteer Group led by Dr Murray, consisting of 35 hospitals from across England, Scotland and Wales. The audit was initiated because of concerns from anaesthetists and surgeons that there was little data available to help hospitals guide and improve performance. Dr Murray’s team found that operation mortality rates varied from 3.6% for the best performing hospital to 41.7% for the worst. Across all the hospitals combined, the time of day the surgery took place was a major factor, with 8 am to 6 pm the safest time of day with a 30-day mortality of 14% and the highest proportion of operations with consultant anaesthetists (76%) and/or consultant surgeons (81%) present. From 6pm to midnight mortality increased to 17%, while anaesthetist and surgeon presence fell to 55% and 68% respectively. The most dangerous time (while also the time with the lowest proportion of operations) was midnight to 8 am, with a mortality of 20%, and anaesthetists attending 41% of operations and surgeons 62%. Overall, 30-day mortality for the operation was 15%, increasing to 24% for patients aged 80 years and over. Mortality was lowest in those aged 50 years and under, at 10%. “The data confirm emergency laparotomy in the UK carries a high mortality. The huge variation in clinical management and outcomes indicates the need for a national quality improvement programme,” said Prof. Grocott. A full national audit will begin in 2013, while the results and identities of contributing hospitals are to be published in 2015.
