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“Comparison of major abdominal emergency surgery outcomes across organisational models of emergency surgical care: analysis of the UK NELA national database”

Anand, Easan; Rahman, Saqib A; Tomlinson, Christopher; Mercer, Stuart J; Pucher, Philip H; (2023) “Comparison of major abdominal emergency surgery outcomes across organisational models of emergency surgical care: analysis of the UK NELA national database”. Journal of Trauma and Acute Care Surgery 10.1097/TA.0000000000004056. (In press).

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Abstract

Background : Emergency General Surgery (EGS) admissions account for a large proportion of surgical care and represent the majority of surgical patients who suffer in-hospital mortality. Healthcare systems continue to experience growing demand for emergency services: one way in which this is being increasingly addressed is dedicated subspecialty teams for emergency surgical admissions, most commonly termed ‘Emergency General Surgery’(EGS) in the UK. This study aims to understand the impact of the emergency general surgery model of care on outcomes from emergency laparotomies.// Methods: Data was obtained from the National Emergency Laparotomy Audit (NELA) database. Patients were dichotomised into EGS hospital or non EGS Hospital. EGS hospital is defined as a hospital where >50 % of in-hours emergency laparotomy operating is performed by an emergency general surgeon. The primary outcome was in – hospital mortality. Secondary outcomes were Intensive Therapy Unit (ITU) length of stay and duration of hospital stay. A propensity score weighting approach was used to reduce confounding and selection bias.// Results: 115,509 patients from 175 hospitals were included in the final analysis. The EGS hospital care group included 5,789 patients vs 109,720 patients in the non EGS group. Following propensity score weighting, mean standardised mean difference reduced from 0.055 to <0.001. In-hospital mortality was similar (10.8% vs 11.1%, p = 0.094), with mean length of stay (16.7 vs 16.1 days, p < 0.001) and ITU stay (2.8 vs 2.6 days, p < 0.001) persistently longer in patients treated in EGS systems.// Conclusion: No significant association between the emergency surgery hospital model of care and in – hospital mortality in emergency laparotomy patients was seen. There is a significant association between the emergency surgery hospital model of care and an increased length of ITU stay and overall hospital stay. Further studies are required to examine the impact of changing models of EGS delivery in the UK.

Type: Article
Title: “Comparison of major abdominal emergency surgery outcomes across organisational models of emergency surgical care: analysis of the UK NELA national database”
DOI: 10.1097/TA.0000000000004056
Publisher version: https://doi.org/10.1097/ta.0000000000004056
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher's terms and conditions.
Keywords: NELA, Laparotomy, Emergency General Surgery, Acute Care Surgery
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Health Informatics
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Health Informatics > Clinical Epidemiology
URI: https://discovery.ucl.ac.uk/id/eprint/10172883
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