Colleges to conduct laparotomy audit

ANZCA and RACS are running a 12-month bi-national pilot study on emergency laparotomies and are seeking hospitals wanting to become involved.
The Australian and New Zealand Emergency Laparotomy Audit - Quality Improvement

Emergency laparotomies (EL) are a common operation frequently undertaken in an elderly, acutely unwell and high-risk patient.

Almost all studies undertaken prior to 2012 were based on retrospective administrative data and reported an overall mortality of 15 per cent, and over 25 per cent in those >80 years. There were substantial inter-hospital variations in outcome and processes of care. There was no multi-hospital data from Australia or New Zealand.

The United Kingdom (UK) Emergency Laparotomy Network, one of the first prospective multi-hospital studies, confirmed an overall 30-day mortality of 15 per cent and noted wide inter-hospital variation in outcomes and process of care. At the same time a prospective quality improvement (QI) study in four hospitals in south-east England reported a reduction in risk adjusted 30-day mortality from 15.6 per cent to 9.6 per cent (p<0.003).

More recently a QI study from Copenhagen has also reported improved outcomes.

These data prompted the UK government to commission the National Emergency Laparotomy Audit (NELA) in England and Wales. NELA’s aim is to collect and publish high quality comparative information in order to drive quality improvement. An important component of the NELA was the prospective documentation of risk and its use to guide escalation in care. The first three annual reports have demonstrated improvements in outcome and care processes. These encouraging results prompted the government to extend funding for a further five years.

In the last 12 months, EL data from several multi-hospital Australian studies suggest that while local mortality maybe lower than that reported overseas, there appear to be the same inter-hospital variations in care and poor compliance with evidence based standards. From these studies it is already clear Australia is different to overseas, notably the much greater proportion of patients transferred as part of their EL care and the number undertaken in the private sector. However, the quality of this Australian data is in no way comparable to that now available overseas.

The surgical and anaesthesia colleges, supported by their specialised societies and sister colleges, believe there is a compelling case for a prospective Australian and New Zealand Emergency Laparotomy Audit (ANZELA).

The value of conducting this as a prospective QI project appears clear and likely to be confirmed when the final results of the Emergency Laparotomy Collaborative are published shortly.

The colleges have agreed to support a 12-month bi-national pilot study, co-led by the Royal Australasian College of Surgeons (RACS) and ANZCA, and this will be used to support a funding application for a more detailed, multi-year bi-national QI study. Funding for this bi-national pilot is being provided by ANZCA and four specialty societies; the General Surgeons of Australia, the New Zealand Association of General Surgeons, the Australian Society of Anaesthetists and the New Zealand Society of Anaesthetists.

Over the past nine months, a working party has agreed the protocols and framework required. Ethical consent has been obtained in both countries for a database that will facilitate prospective real time data collection and feed comparative outcome and process analysis back to participants promptly. ANZELA-QI has gained greatly from the experience, support and advice willingly provided by colleagues in the UK.

Those wishing to support the pilot study should in the first instance contact Katherine Economides at the RACS Research, Audit and Academic Surgery Office in Adelaide. Further information will be available at the RACS stand at the RACS Annual Scientific Congress/ANZCA Annual Scientific Meeting in at the International Convention Centre in Sydney from May 7 to May 11.
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