Initial emergency laparotomy outcomes following a transdisciplinary perioperative care pathway in Singapore

Marc Weijie Ong; Serene Si Ning Goh; Wei Min James Tung; Woan Wui Lim; Hilda Haoling Hu; Choong Yan Lim; Priscilla Ng; Kok Yang Tan; Tiong Thye Jerry Goo

doi:10.1002/ams2.702

Initial emergency laparotomy outcomes following a transdisciplinary perioperative care pathway in Singapore

Acute Med Surg. 2021 Oct 28;8(1):e702. doi: 10.1002/ams2.702. eCollection 2021 Jan-Dec.

Authors

Marc Weijie Ong¹, Serene Si Ning Goh¹, Wei Min James Tung², Woan Wui Lim¹, Hilda Haoling Hu³, Choong Yan Lim⁴, Priscilla Ng⁴, Kok Yang Tan¹, Tiong Thye Jerry Goo¹

Affiliations

¹ Department of General Surgery Khoo Teck Puat Hospital Singapore City Singapore.
² Lee Kong Chian School of Medicine Nanyang Technological University Singapore City Singapore.
³ Department of Anaesthesia Khoo Teck Puat Hospital Singapore City Singapore.
⁴ Department of Geriatric Medicine Khoo Teck Puat Hospital Singapore City Singapore.

Abstract

Aim: Emergency laparotomy (EL) is a common surgery associated with high morbidity and mortality. An enhanced care pathway incorporates evidence-based care bundles with the aim of providing standardized perioperative care. Prior to 2019, EL management in our institution was not standardized. This study aims to assess whether implementation of a transdisciplinary perioperative Emergency Laparotomy (ELAP) pathway improves clinical and efficiency outcomes of EL.

Methods: A prospective single-center audit was undertaken between 1 January and 31 December, 2019 following the implementation of the ELAP pathway. Comparisons were made with retrospective data from the preimplementation period between 1 January and 31 December, 2017. Demographics and clinical and efficiency outcomes were compared for patients (age > 16 years old) requiring EL for acute abdominal conditions.

Results: There were 152 and 162 patients from preimplementation and postimplementation periods, respectively. There was a nonsignificant reduction of 30-day mortality in the intervention group receiving perioperative pathway care compared with the preintervention group (3.1% versus 5.3%, respectively; P = 0.40). There was a decrease in postoperative complications in the intervention group, in particular for Clavien-Dindo IV complications (11.2% versus 3.1%, p < 0.01). Efficiency outcomes improved postimplementation with increased consultant surgeon and anesthetist presence in operating theater and postoperative geriatric assessment for elderly patients. There was an overall reduction in cost of hospital stay from S$32,128 to $27,947 (p = 0.24).

Conclusion: Implementation of a transdisciplinary perioperative care pathway was associated with significant reduction in postoperative complications, improvement in 30-day mortality and efficiency outcomes at reduced hospital costs for patients following EL in our institution.

Keywords: Emergency surgery; laparotomy; perioperative care; transdisciplinary.