Standardized Treatment Methods in 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
• 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.

Key Findings

• There were 1344 patients in all, including 663 in the control group and 681 in the intervention group.
• 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).
• There were fewer anastomoses (22.5 versus 16.8 percent).
• 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).
• 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