Standardized management protocols improve outcomes after emergency laparotomy

Following an emergency laparotomy, standardized treatment methods enhanced results, says an article published in the British Journal of Surgery. Acute high-risk abdominal surgery is prevalent, as are the risks of organ failure, the requirement for intensive care, death, and a lengthy hospital stay. Terje Timan and colleagues conducted this study to evaluate the application of standardized management.

A prospective analysis of all persons undergoing emergency laparotomy was conducted over a 42-month period (2018-2021), and the results were compared to those of a retrospective control group. For all patients, a new standardized clinical protocol was implemented, which included prompt bedside physical evaluation by the surgeon and anesthetist, interprofessional communication regarding resuscitation location, elimination of unnecessary factors that could delay surgery, enhanced operating theater competence, enhanced recovery care, regular epidural, and regular early warning scores. The 30-day mortality rate was the main outcome. The duration of hospital stay, the requirement for critical care, and surgical complications were secondary objectives.

The key findings of this study were:

1. There were 1344 patients in all, including 663 in the control group and 681 in the intervention group.

2. The revised strategy shortened the time between the decision to operate and the commencement of surgery (3.80 against 3.22 h) and increased the usage of antibiotics (81.4 versus 94.7 percent).

3. There were fewer anastomoses (22.5 versus 16.8 percent).

4. The 30-day mortality rate in the historical control group was 14.5%, while it was 10.7% in the intervention group (P = 0.045).

5. The average length of stay in the hospital (11.9 vs 10.2 days; P = 0.007) and ICU (5.40 versus 3.12 days; P = 0.007) was similarly reduced. Serious surgical complications (grade IIIb-V) were less common (37.6 versus 27.3%; P = 0.001).

Reference:

Timan, T. J., Karlsson, O., Sernert, N., & Prytz, M. (2023). Standardized perioperative management in acute abdominal surgery: Swedish SMASH controlled study. In British Journal of Surgery. Oxford University Press (OUP). https://doi.org/10.1093/bjs/znad081