The National Emergency Laparotomy Audit team, a group of experts in their field, were recently commissioned by the Healthcare Quality Improvement Partnership to conduct an audit into emergency laparotomies.
The audit, the first of its kind, reviewed the treatment received by 20,000 patients at 192 hospitals in England and Wales. Sadly their findings revealed that around 1 in 10 patients dies within 30 days of undergoing urgent, unplanned laparotomy.
The audit shows that whilst some hospitals are good at ensuring that a high proportion of patients are well looked after, the large minority are not and this reduces their chance of survival post surgery. In some hospitals the expected standards of care were not met for 30-40% of patients. The failure to ensure that the care of all patients meets 12 set standards from initial assessment through to post operative care compromises survival rate.
Leading the team, Dr David Murray, a Consultant Anaesthetist at James Cook Hospital in Middlesborough said “This is among the riskiest types of surgery. We believe if more hospitals met the standards of care, then the death rates would come down”.
The inquiry found that only half of patients needing emergency bowel surgery were seen by a specialist within the recommended 12 hours of admission to hospital. At 49 hospitals, fewer than 40% of patients were reviewed within that timeframe.
Many patients at risk of death because of sepsis had to wait far longer than they should to receive antibiotics, with 25% waiting more than 7 hours.
Patients should be assessed for risks of complications and death prior to surgery however only 56% were assessed. Under the guidelines where a risk of death was recorded as 5% or more, patients should have had the involvement of a consultant surgeon and consultant anaesthetist, however a third did not.
In addition, access post-operatively to critical or intensive care wards was inadequate with 4 in 10 patients not being admitted to such wards, despite a guideline that all patients should be.
Mr Iain Anderson, the lead surgeon involved in the audit said many clinical teams had already reviewed and improved the way they delivered care and he urged other hospitals to follow suit.
The audit team will be following up with the best and worst hospitals to understand what was being done well and sharing best practice to improve performance where necessary.
Common bowel problems are routinely dealt with by laparotomy surgery and if post-operative care is compromised, deterioration can be rapid leading to death or in many cases, survival but with serious and life changing problems. It is welcome that outcomes are being addressed for the many patients who undergo such procedures every year.
If you or your family have been affected by the issues set out in this article then please contact Sarah Burgess or any member of our Clinical Negligence Team Sarah.Burgess@clarkewillmott.com.