Improving Outcomes of Emergency Bowel Surgery Using NELA Model

Journal of the College of Physicians and Surgeons Pakistan

article

Rizwan Sultan¹  Hasnain Zafar¹ 

[1] Department of Surgery, The Aga Khan University Hospital

关键词: Emergency laparotomy;    Outcome;    Bowel surgery;    NELA model.;   

学科分类：医学（综合）

来源: College of Physicians and Surgeons Pakistan. Journal

【 摘 要 】

Objective: To find outcomes of emergency bowel surgery and review the processes involved in the care of these patientson the same template used in National Emergency Laparotomy Audit (NELA).Study Design: An audit.Place and Duration of Study: Surgery Department, The Aga Khan University Hospital, Karachi, from December 2013 toNovember 2014.Methodology: Patients undergone emergency bowel surgery during the review period were included. Demographic data,type of admission, ASA grade, urgency of surgery, P-POSSUM score, indication of surgery, length of stay and outcomewas recorded. Data was then compared with the data published by NELA team in their first report. P-value for categoricalvariables was calculated using Chi-square tests.Results: Although the patients were younger with nearly same spectrum of disease, the mortality rate was significantlymore than reported in NELA (24% versus 11%, p=0.004). Comparison showed that care at AKUH was significantly lackingin terms of proper preoperative risk assessment and documentation, case booking to operating room timing, intraoperativegoal directed fluid therapy using cardiac output monitoring, postoperative intensive care for highest risk patients andreview of elderly patients by MCOP specialist.Conclusion: This study helped in understanding the deficiencies in the care of patients undergoing emergency bowelsurgery and alarmingly poor outcomes in a very systematic manner. In view of results of this study, it is planned to dointerventions in the deficient areas to improve care given to these patients and their outcomes with the limited resourcesof a developing country.

【 授权许可】

CC BY