Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Jan 8;5(1):zraa060.
doi: 10.1093/bjsopen/zraa060.

Failure to rescue patients after emergency laparotomy for large bowel perforation: analysis of the National Emergency Laparotomy Audit (NELA)

O Peacock  1 , F Yanni  2 , A Kuryba  3 , D Cromwell  3   4 , S Lockwood  5 , I Anderson  6 , R S Vohra  2 ; NELA Project Team
Collaborators, Affiliations

Failure to rescue patients after emergency laparotomy for large bowel perforation: analysis of the National Emergency Laparotomy Audit (NELA)

O Peacock et al. BJS Open. .

Abstract
in English, Spanish

Background: Past studies have highlighted variation in in-hospital mortality rates among hospitals performing emergency laparotomy for large bowel perforation. The aim of this study was to investigate whether failure to rescue (FTR) contributes to this variability.

Methods: Patients aged 18 years or over requiring surgery for large bowel perforation between 2013 and 2016 were extracted from the National Emergency Laparotomy Audit (NELA) database. Information on complications were identified using linked Hospital Episode Statistics data and in-hospital deaths from the Office for National Statistics. The FTR rate was defined as the proportion of patients dying in hospital with a recorded complication, and was examined in hospitals grouped as having low, medium or high overall postoperative mortality.

Results: Overall, 6413 patients were included with 1029 (16.0 per cent) in-hospital deaths. Some 3533 patients (55.1 per cent) had at least one complication: 1023 surgical (16.0 per cent) and 3332 medical (52.0 per cent) complications. There were 22 in-hospital deaths following a surgical complication alone, 685 deaths following a medical complication alone, 150 deaths following both a surgical and medical complication, and 172 deaths with no recorded complication. The risk of in-hospital death was high among patients who suffered either type of complication (857 deaths in 3533 patients; FTR rate 24.3 per cent): 172 deaths followed a surgical complication (FTR-surgical rate 16.8 per cent) and 835 deaths followed a medical complication (FTR-medical rate of 25.1 per cent). After adjustment for patient characteristics and hospital factors, hospitals grouped as having low, medium or high overall postoperative mortality did not have different FTR rates (P = 0.770).

Conclusion: Among patients having emergency laparotomy for large bowel perforation, efforts to reduce the risk of in-hospital death should focus on reducing avoidable complications. There was no evidence of variation in FTR rates across National Health Service hospitals in England.

Antecedentes: Estudios anteriores han puesto de manifiesto la variación en las tasas de mortalidad hospitalaria entre los hospitales que realizan laparotomía de urgencia por perforación de colon. El objetivo de este estudio fue investigar si el fracaso en el rescate (failure to rescue, FTR) contribuye a esta variabilidad.

Métodos: Los pacientes de 18 años o más que requirieron cirugía por perforación del intestino grueso entre 2013 y 2016 se extrajeron de la base de datos de la National Emergency Laparotomy Audit (NELA). La información sobre las complicaciones se identificó utilizando datos vinculados de estadísticas de episodios hospitalarios (Hospital Episode Statistics, HES) y muertes intrahospitalarias de la Oficina de Estadísticas Nacionales (Office for National Statistics, ONS). La tasa de FTR se definió como la proporción de pacientes que fallecieron en el hospital con una complicación registrada, analizándose en los hospitales agrupados según la mortalidad postoperatoria general fuera baja, media o alta.

Resultados: En total, se incluyeron 6.413 pacientes con 1.029 (16,0%) muertes intrahospitalarias. Un total de 3.533 (55,1%) pacientes tuvieron al menos una complicación: 1.023 (16,0%) una complicación quirúrgica y 3.332 (52,0%) una complicación médica. Hubo 22 muertes intrahospitalarias después de solo una complicación quirúrgica, 685 muertes después de solo una complicación médica, 150 muertes después de una complicación quirúrgica y médica y 172 muertes sin ninguna complicación registrada. El riesgo de mortalidad hospitalaria fue alto entre los pacientes que sufrieron cualquier tipo de complicación (857 muertes; tasa de FTR 24,3%): 172 muertes siguieron a una complicación quirúrgica (tasa de FTR-quirúrgica 16,8%) y 835 muertes siguieron a una complicación médica (tasa FTR-médica del 25,1%). Tras el ajuste de las características de los pacientes y los factores hospitalarios, los hospitales agrupados en mortalidad postoperatoria global baja, media o alta no tuvieron tasas de FTR diferentes (P = 0,770).

Conclusión: Entre los pacientes que se someten a laparotomía de urgencia por perforación del intestino grueso, los esfuerzos para reducir el riesgo de muerte intrahospitalaria deben centrarse en reducir las complicaciones evitables. No hubo evidencia de variación en las tasas de FTR entre los hospitales del NHS en Inglaterra.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Flow diagram showing the distribution of patient characteristics and operative findings by complication groups NELA, National Emergency Laparotomy Audit; HES, Hospital Episode Statistics; EL, emergency laparotomy.
Fig. 2
Fig. 2
Funnel plots of observed and adjusted in-hospital mortality in 188 hospitals that performed 10 or more operations for large bowel perforation a Observed and b adjusted 30-day morality rate.
See this image and copyright information in PMC

References

    1. National Emergency Laparotomy Audit. The Third Patient Report of the National Emergency Laparotomy Audit (NELA) 2017. http://www.nela.org.uk/reports (accessed 22 April 2019)
    1. Sartelli M, Catena F, Ansaloni L, Coccolini F, Corbella D, Moore EE et al. Complicated intra-abdominal infections worldwide: the definitive data of the CIAOW Study. World J Emerg Surg 2014;9:37. - PMC - PubMed
    1. Bielecki K, Kamiński P, Klukowski M. Large bowel perforation: morbidity and mortality. Tech Coloproctol 2002;6:177–182 - PubMed
    1. Biondo S, Ramos E, Deiros M, Martı’ Ragué J, De Oca J, Moreno P et al. Prognostic factors for mortality in left colonic peritonitis: a new scoring system. J Am Coll Surg 2000;191:635–642 - PubMed
    1. Kriwanek S, Armbruster C, Beckerhinn P, Ditrich K. Prognostic factors for survival in colonic perforation. Int J Colorectal Dis 1994;9:158–162 - PubMed