Time for metrics in emergency surgical care – the role of an emergency surgery registry

Parlour, Randal; Johnson, Alison; Loughlin, Paula; Watson, Angus; Sugrue, Michael; Drake, Anne

doi:10.5114/ait.2019.87360

Cited by 8 publications

(5 citation statements)

References 27 publications

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“…Insufficient data on EGS outcomes, due to the absence of large-scale patient-level EGS registries, make it difficult to identify patients a priori who are at greater risk of needing surgical rescue. Therefore, more intense efforts should be undertaken to develop EGS registries to better understand how patient-relevant elements interface with the complex systems involved in EGS care delivery [ 30 ].…”

Section: Pre-hospital Care and Care Prior To Inter-hospital Transfermentioning

confidence: 99%

“…Accurate analysis and health system integration is exemplified by the Emergency Surgery Outcome Advancement Program eSOAP that helps drives reduced complication and mortality rates [ 70 , 71 ], ESTES research strategy can lead the way. These priorities are relevant for ESTES considering its expanding research vision that targets life-saving interventions [ 30 ].…”

Section: Data Registries and Prospective Snapshot Audit Analysesmentioning

confidence: 99%

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European society for trauma and emergency surgery member-identified research priorities in emergency surgery: a roadmap for future clinical research opportunities

Bass,

Kaplan,

Gaarder

et al. 2024

Eur J Trauma Emerg Surg

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Background European Society for Trauma and Emergency Surgery (ESTES) is the European community of clinicians providing care to the injured and critically ill surgical patient. ESTES has several interlinked missions – (1) the promotion of optimal emergency surgical care through networked advocacy, (2) promulgation of relevant clinical cognitive and technical skills, and (3) the advancement of scientific inquiry that closes knowledge gaps, iteratively improves upon surgical and perioperative practice, and guides decision-making rooted in scientific evidence. Faced with multitudinous opportunities for clinical research, ESTES undertook an exercise to determine member priorities for surgical research in the short-to-medium term; these research priorities were presented to a panel of experts to inform a ‘road map’ narrative review which anchored these research priorities in the contemporary surgical literature. Methods Individual ESTES members in active emergency surgery practice were polled as a representative sample of end-users and were asked to rank potential areas of future research according to their personal perceptions of priority. Using the modified eDelphi method, an invited panel of ESTES-associated experts in academic emergency surgery then crafted a narrative review highlighting potential research priorities for the Society. Results Seventy-two responding ESTES members from 23 countries provided feedback to guide the modified eDelphi expert consensus narrative review. Experts then crafted evidence-based mini-reviews highlighting knowledge gaps and areas of interest for future clinical research in emergency surgery: timing of surgery, inter-hospital transfer, diagnostic imaging in emergency surgery, the role of minimally-invasive surgical techniques and Enhanced Recovery After Surgery (ERAS) protocols, patient-reported outcome measures, risk-stratification methods, disparities in access to care, geriatric outcomes, data registry and snapshot audit evaluations, emerging technologies interrogation, and the delivery and benchmarking of emergency surgical training. Conclusions This manuscript presents the priorities for future clinical research in academic emergency surgery as determined by a sample of the membership of ESTES. While the precise basis for prioritization was not evident, it may be anchored in disease prevalence, controversy around aspects of current patient care, or indeed the identification of a knowledge gap. These expert-crafted evidence-based mini-reviews provide useful insights that may guide the direction of future academic emergency surgery research efforts.

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Section: Pre-hospital Care and Care Prior To Inter-hospital Transfermentioning

confidence: 99%

Section: Data Registries and Prospective Snapshot Audit Analysesmentioning

confidence: 99%

European society for trauma and emergency surgery member-identified research priorities in emergency surgery: a roadmap for future clinical research opportunities

Bass,

Kaplan,

Gaarder

et al. 2024

Eur J Trauma Emerg Surg

Self Cite

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“…Newly formed emergency surgical societies, such as The World Society of Emergency Surgery (WSES) and initiatives to improve outcomes, are addressing the lack of data in this area [4,48]. However, there remains the need for more robust clinical outcome data, registries and audits [4,49]. Variability in care also remains a huge challenge [50].…”

Section: Discussionmentioning

confidence: 99%

Systematic Review and Meta-Analysis of Wound Bundles in Emergency Midline Laparotomy Identifies That It Is Time for Improvement

McGeehan

Edelduok

Bucholc

et al. 2021

Life

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Background: Emergency midline laparotomy is the cornerstone of survival in patients with peritonitis. While bundling of care elements has been shown to optimize outcomes, this has focused on elective rather than emergency abdominal surgery. The aim of this study was to undertake a systematic review and meta-analysis of factors affecting the development of surgical site infection (SSI) in patients undergoing midline emergency laparotomy. Methods: An ethically approved, PROSPERO registered (ID: CRD42020193246) meta-analysis and systematic review, searching PubMed, Scopus, Web of Science and Cochrane Library electronic databases from January 2015 to June 2020 and adhering to PRISMA guidelines was undertaken. Search headings included “emergency surgery”, “laparotomy”, “surgical site infection”, “midline incision” and “wound bundle”. Suitable publications were graded using Methodological Index for Non-Randomised Studies (MINORS); papers scoring ≥16/24 were included for data analysis. The primary outcome in this study was SSI rates following the use of wound bundles. Secondary outcomes consisted of the effect of the individual interventions included in the bundles and the SSI rates for superficial and deep infections. Five studies focusing on closure techniques were grouped to assess their effect on SSI. Results: This study identified 1875 articles. A total of 58 were potentially suitable, and 11 were included after applying MINORS score. The final cohort included 2,856 patients from eight countries. Three papers came from the USA, two papers from Japan and the remainder from Denmark, England, Iran, Netherlands, Spain and Turkey. There was a 32% non-significant SSI reduction after the implementation of wound bundles (RR = 0.68; CI, 0.39–1.17; p = 0.16). In bundles used for technical closure the reduction in SSI of 15% was non-significant (RR = 0.85; CI, 0.57–1.26; p = 0.41). Analysis of an effective wound bundle was limited due to insufficient data. Conclusions: This study identified a significant deficit in the world literature relating to emergency laparotomy and wound outcome optimisation. Given the global burden of emergency general surgery urgent action is needed to assess bundle’s ability to potentially improve outcome after emergency laparotomy.

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“…While patient safety in surgery has received a significant amount of attention in the past decade since the global implementation of the WHO “Surgical Safety Checklist” [ 6 ], emergency general surgery (EGS) still represents a neglected entity in the field of patient safety [ 44 – 46 ]. This notion is highly concerning because the rate of postoperative complications is drastically higher in EGS than in elective surgery, and associated with an eightfold increased mortality (Fig.…”

Section: Surgeon-related Risk Factorsmentioning

confidence: 99%

The role of teamwork and non-technical skills for improving emergency surgical outcomes: an international perspective

et al. 2022

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The assurance of patient safety in emergency general surgery remains challenging due to the patients’ high-risk underlying conditions and the wide variability in emergency surgical care provided around the globe. The authors of this article convened as an expert panel on patient safety in surgery at the 8th International Conference of the World Society of Emergency Surgery (WSES) in Edinburgh, Scotland, on September 7–10, 2021. This review article represents the proceedings from the expert panel discussions at the WSES congress and was designed to provide an international perspective on optimizing teamwork and non-technical skills in emergency general surgery.

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Time for metrics in emergency surgical care – the role of an emergency surgery registry

Cited by 8 publications

References 27 publications

European society for trauma and emergency surgery member-identified research priorities in emergency surgery: a roadmap for future clinical research opportunities

European society for trauma and emergency surgery member-identified research priorities in emergency surgery: a roadmap for future clinical research opportunities

Systematic Review and Meta-Analysis of Wound Bundles in Emergency Midline Laparotomy Identifies That It Is Time for Improvement

The role of teamwork and non-technical skills for improving emergency surgical outcomes: an international perspective

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