Mortality for emergency laparotomy is not affected by the weekend effect: a multicentre study

Nageswaran, H.; Rajalingam, Vijayendran; Sharma, Anil Kumar; Joseph, Akodjenou; Davies, M.; Jones, H; Evans, Martyn

doi:10.1308/rcsann.2019.0037

Cited by 10 publications

(10 citation statements)

References 24 publications

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“…Considering the heterogeneity of patients presenting for emergency surgery, the decision-making process must not be influenced by the time of the surgery but be based on objective risk stratification score. [ 22 23 ] Similarly, in our hospital, oncology cases needing urgent surgery may not necessarily be sick to withstand surgery. Change in attitude towards pain management during after hours is not just a reflection of the experience, but a change in priority of the senior-most anaesthesiologist conducting the case.…”

Section: Discussionmentioning

confidence: 96%

Audit of pain management following emergency laparotomies in cancer patients: A prospective observational study from an Indian tertiary care hospital

2020

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Background: Emergency laparotomies present a challenge in pain management given sick patients, odd timings and poor outcomes. Current recommendations favour multimodal opioid-sparing analgesia following elective laparotomies. No recommendation exists for emergency surgeries. Methodology: After approval and registration of the trial, adult patients posted for emergency laparotomy in the hospital (tertiary centre for cancer care) starting August 2015, for 6 months, were included in this prospective study. Patients' details including indication for emergency surgery, preoperative haemodynamic parameters, baseline coagulation status were captured. Patients were followed for pain scores, satisfaction with pain management and outcome. The number of anaesthesiologists present and their experience concerning regional techniques were noted. Results: Intestinal obstruction was the commonest cause of emergency laparotomy. Most patients belonged to the ASA IE/IIE class (91%). Intraoperatively, opioids were the mainstay of pain management with an epidural catheter inserted in only 9% of cases even though most cases were conducted by anaesthesiologists confident/expert in thoracic epidural insertion. There was no correlation of choice of pain management technique with the time of surgery ( P = 0.22), ASA grading ( P = 0.28), predicted mortality by p-Possum scores ( P = 0.24). Pain at movement was moderate-severe in more than 50% of patients within the first 24 h. The regional group had better satisfaction when compared to opioid and non-opioid based management. ( P < 0.001). Conclusion: Regional techniques for pain management in emergency laparotomies are less preferred, therefore, opioids are the mainstay. Lack of experience is essentially not the primary reason for regional techniques not gaining popularity. Pain management in this group needs a thorough re-evaluation.

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Section: Discussionmentioning

confidence: 96%

Audit of pain management following emergency laparotomies in cancer patients: A prospective observational study from an Indian tertiary care hospital

2020

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“…Our study showed no significant differences in post-operative LOS and mortality with respect to the day of surgery (WE vs WD). Moreover, recent improvements in healthcare within the UK, including more protocol-based management of sepsis, better access to intensive care beds, and care for patients requiring emergency abdominal surgery, might have controlled the weekend effect [ 25 ]. Differences in staffing levels and availability of resources at weekends may explain the observed variability of weekend effects across the world; however, the current literature does not provide adequate evidence to compare the structure of the on-call emergency general surgery team on weekends in different countries and continents.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Weekend Surgery on Outcomes of Emergency Laparotomy: Experience at a High Volume District General Hospital

Patel¹,

Thomas²,

Aguayo³

et al. 2022

Cureus

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Aims Emergency laparotomies (ELs) are associated with significant morbidity and mortality. Delays to the theater are inevitably associated with worse outcomes. Higher mortality has been reported with admissions over the weekend. The aim of this study is to compare the delays and outcomes of emergency laparotomies performed on weekdays (WD) and weekends (WE) at a high-volume, large district general hospital. Methods A retrospective review of a prospectively maintained database was performed for all patients who underwent general surgical emergency laparotomy between June and October 2021. Patient outcomes were compared between delayed and non-delayed surgeries as per the NCEPOD (National Confidential Enquiry into Patient Outcomes and Death) classification. The primary outcome compared was the 30-day post-operative mortality and morbidity determined by the Clavein-Dindo class ≥2. Secondary outcomes included the time from booking to anaesthesia start time, i.e., time to theatre (TTT), delay in surgery, out-of-hours (OOH) surgery, and unplanned return to theatres. Results Of the 103 laparotomies included, 33% were performed over the weekend. The most common indication for emergency laparotomy was bowel obstruction (53.4 %), followed by perforation (28.2%). There was no significant difference in mortality, the TTT (p = 0.218), delay in surgery with respect to the NCEPOD category of intervention (p = 0.401), postoperative length of stay (p = 0.555), number of cases operated OOH as well as unplanned return to theatres. There was a significant difference in the morbidity of patients between the two groups (Clavein-Dindo class ≥2, p = 0.021). Conclusion With consistent consultant involvement, an equivalent standard of weekend emergency surgical service can be delivered.

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“…For specific surgical procedures, such as lysis of adhesions or partial colectomy, a higher postoperative mortality was observed for patients operated on the weekend [ 2 ]. However, patient data from different countries contradicted these results, showing no influence of the weekday on postoperative short- and long-term patient outcome [ 5 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

“…Factors that explain differences in risk adjusted mortality after general surgical emergencies in England have been identified, but the outcome measures relate to the day of admission not surgical treatment [ 7 ]. Of note, no difference in postoperative mortality by day of emergency general surgery has been observed [ 5 , 6 ]. Data on the quality of surgical treatment and oncological outcome of the resected patients is missing.…”

Section: Introductionmentioning

confidence: 99%

Is there a weekend effect in emergency surgery for colorectal carcinoma? Analysis from the German StuDoQ registry

et al. 2022

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Background Higher postoperative mortality has been observed among patients who received emergency colorectal surgery on the weekend compared to during the week. The aim of this study was to determine whether the weekday of emergency surgery affects the 30-day mortality and postoperative course in emergency colorectal surgery. Methods Prospectively acquired data from the 2010–2017 German StuDoQ|Colorectal surgery registries were analysed. Differences in 30-day mortality, transfer and length of stay (MTL30) (primary endpoints), postoperative complications, length of stay and pathological results of resected specimens (secondary endpoints) were assessed. Multivariable analysis was performed to identify independent risk factors for postoperative outcome. Results In total, 1,174 patients were included in the analysis. Major postoperative complications and the need for reoperation were observed more frequently for emergency colorectal surgery performed during the week compared to the weekend (23.01 vs. 15.28%, p = 0.036 and 17.96% vs. 11.11%, p = 0.040, respectively). In contrast, patients who received emergency surgery on the weekend presented with significantly higher UICC tumour stages (UICC III 44.06 vs. 34.15%, p = 0.020) compared to patients with emergency colorectal surgery on a weekday. Emergency surgery performed during the week was an independent risk factor for the development of severe postoperative complications (OR 1.69 [1.04–2.74], p = 0.033) and need for reoperation (OR 1.79 [1.02–3.05], p = 0.041) in the multivariable analysis. Conclusion Emergency surgery for colorectal carcinoma in Germany is performed with equal postoperative MTL30 and mortality throughout the entire week. However, emergency surgery during the week seems to be associated with a higher rate of severe postoperative complications and reoperation.

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Mortality for emergency laparotomy is not affected by the weekend effect: a multicentre study

Cited by 10 publications

References 24 publications

Audit of pain management following emergency laparotomies in cancer patients: A prospective observational study from an Indian tertiary care hospital

Audit of pain management following emergency laparotomies in cancer patients: A prospective observational study from an Indian tertiary care hospital

The Effect of Weekend Surgery on Outcomes of Emergency Laparotomy: Experience at a High Volume District General Hospital

Is there a weekend effect in emergency surgery for colorectal carcinoma? Analysis from the German StuDoQ registry

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