Surgeons are calling for urgent action to address concerns over ‘significant variations in care’ experienced by patients undergoing emergency surgery.
The Royal College of Surgeons reports that, in the UK, 170,000 patients undergo higher-risk, non-cardiac surgery each year – of these patients, 100,000 will develop significant complications resulting in over 25,000 deaths. Complications occur in as many as 50% of patients undergoing some common procedures, and these result in dramatic increases in length of stay and cost. In its latest report, The Higher Risk General Surgical Patient: Towards Improved Care for a Forgotten Group, the RCS states that the perioperative pathway followed by patients requiring emergency surgical management is ‘frequently disjointed, protracted and not always patient centred’. Furthermore, outcomes are known to ‘vary substantially’ and could be considerably improved.
Problems highlighted
The RCS points out that there is growing concern that higher risk, general surgical patients are receiving sub-optimal care. Advanced age, co-morbid disease, major and urgent surgery are some of the key factors associated with increased risk. Within this group, emergency major gastrointestinal surgery has one of the highest mortalities, which can reach 50% in the over 80s. The report points out that this type of surgery is carried out in every acute hospital, but not always with consultant staff present and not always with routine admission to a critical care bed after surgery. Poorly designed hospital services, particularly access to emergency operating theatres and radiology treatment, are among the problems highlighted. This results in patients missing out on early diagnosis and rapid life-saving care. Furthermore, the clinical response for patients who deteriorate is often ‘poorly thought through’ and, at times, ‘ad hoc’. The RCS adds that there is a general lack of appreciation of the level of risk in emergency surgical patients – where death rates of 15% to 20% are typical, and can be as high as 40% in the most elderly patients. Surgeons say this imminent risk of death is not being reflected in the priority given to these patients whose chances of survival can more than double, depending on which NHS hospital they are treated in. The report calls for: •
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