Skip to main content

Advertisement

SpringerLink
Log in

Measuring Outcomes of Clinical Care: Victorian Emergency Laparotomy Audit Using Quality Investigator

  • Original Scientific Report
  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Background

The Australian and New Zealand Audit of Surgical Mortality (ANZASM) National Report 2015 found that within the cohort of audited deaths, 85% were emergencies with acute life-threatening conditions, and by far, the most common procedures were laparotomy and colorectal procedures. Emergency laparotomy outcomes have shown improvement through audit and reporting in the UK. The purpose of this study was to determine the outcome of emergency laparotomy in the state of Victoria, Australia.

Method

The Dr Foster Quality Investigator (DFQI) database was interrogated for a set of Australian Classification of Health Intervention (ACHI) codes defined by the authors as representing an emergency laparotomy. The dataset included patients who underwent emergency laparotomy from July 2007 to July 2016 in all Victorian hospitals.

Results

There were 23,115 emergency laparotomies conducted over 9 years in 66 hospitals. Inpatient mortality was 2036/23,115 (8.8%). Mortality in the adult population increased with age and reached 18.1% in those patients that were 80 years or older. 51.3% were females, and there was no significant difference in survival between genders. Patients with no recorded comorbidities had a mortality of 4.3%, whereas those with > 5 comorbidities had 19.3% mortality.

Conclusion

Administrative data accessed via a tool such as DFQI can provide useful population data to guide further evidence-based improvement strategies. The mortality for emergency laparotomy within Victorian hospitals is comparable, if not better than that seen in overseas studies. There is a need to continue routine audit of mortality rates and implement systems improvement where necessary.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Al-Temimi MH, Griffee M, Enniss TM et al (2012) When is death inevitable after emergency laparotomy? Analysis of the American College of Surgeons National Surgical Quality Improvement Program database. J Am Coll Surg 215:503–511

    Article  PubMed  Google Scholar 

  2. Saunders DI, Murray D, Pichel AC et al (2012) Variations in mortality after emergency laparotomy: the first report of the UK Emergency Laparotomy Network. Br J Anaesth 109:368–375

    Article  PubMed  CAS  Google Scholar 

  3. Azzam DG, Neo CA, Itotoh FE et al (2013) The Western Australian Audit of Surgical Mortality: outcomes from the first 10 years. Med J Aust 199:539–542

    Article  PubMed  Google Scholar 

  4. Beiles CB, Retegan C, Maddern GJ (2015) Victorian Audit of Surgical Mortality is associated with improved clinical outcomes. ANZ J Surg 85:803–807

    Article  PubMed  Google Scholar 

  5. Watters DA, Hollands MJ, Gruen RL et al (2015) Perioperative mortality rate (POMR): a global indicator of access to safe surgery and anaesthesia. World J Surg 39:856–864

    Article  PubMed  Google Scholar 

  6. Surgeons RACo (2016) Australian and New Zealand audit of surgical mortality national report 2015

  7. Surgeons RACo (2016) Victorian audit of surgical mortality report 2015

  8. Crebbin W, Beasley SW, Watters DA (2013) Clinical decision making: how surgeons do it. ANZ J Surg 83:422–428

    Article  PubMed  Google Scholar 

  9. Milnes S, Orford NR, Berkeley L et al (2015) A prospective observational study of prevalence and outcomes of patients with Gold Standard Framework criteria in a tertiary regional Australian Hospital. BMJ Support Palliat Care

  10. Orford NR, Milnes SL, Lambert N et al (2016) Prevalence, goals of care and long-term outcomes of patients with life-limiting illness referred to a tertiary ICU. Crit Care Resusc 18:181–188

    PubMed  Google Scholar 

  11. Tan BH, Mytton J, Al-Khyatt W et al (2016) A Comparison of mortality following emergency laparotomy between populations from New York State and England. Ann Surg

  12. RCoA (2016) The second patient report of the national emergency laparotomy audit (NELA)

  13. Collaborative G (2016) Mortality of emergency abdominal surgery in high-, middle- and low-income countries. Br J Surg 103:971–988

    Article  Google Scholar 

  14. Patel AA, Singh K, Nunley RM et al (2016) administrative databases in orthopaedic research: pearls and pitfalls of big data. J Am Acad Orthop Surg 24:172–179

    Article  PubMed  Google Scholar 

  15. Statistics ABo Australian Demographic Statistics, cat. no. 3101.0 viewed 01 Mar 2017. http://www.abs.gov.au/AUSSTATS/abs@.nsf/allprimarymainfeatures/61D19DFBD033B48FCA257CA7000DCB16?opendocument

  16. RCoA (2015) The first patient report of the national emergency laparotomy audit

  17. Elixhauser A, Steiner C, Harris D et al (1998) Comorbidity measures for use with administrative data. MedCare 36:8–27

    CAS  Google Scholar 

  18. American College of Surgeons national surgical quality improvement program. http://site.acsnsqip.org/

  19. The Doctor Foster Global Comparators Study. http://drfosterintelligence.co.uk/global-comparators/

  20. The enhanced peri-operative care for high-risk patients (EPOCH) trial. http://www.epochtrial.org/epoch.php

  21. Fletcher A, Worthington D (2009) What is a ‘generic’ hospital model?—a comparison of ‘generic’ and ‘specific’ hospital models of emergency patient flows. Health Care Manag Sci 12:374–391

    Article  PubMed  Google Scholar 

  22. Nagaraja V, Eslick GD, Cox MR (2014) The acute surgical unit model verses the traditional “on call” model: a systematic review and meta-analysis. World J Surg 38:1381–1387

    Article  PubMed  Google Scholar 

  23. Truskett P (2010) Acute surgery units: the future face of emergency surgery. ANZ J Surg 80:477–478

    Article  PubMed  Google Scholar 

  24. Raju RS, Guy GS, Majid AJ et al (2015) The Australian and New Zealand audit of surgical mortality-birth, deaths, and carriage. Ann Surg 261:304–308

    Article  PubMed  CAS  Google Scholar 

  25. Weiser TG, Haynes AB, Dziekan G et al (2010) Effect of a 19-item surgical safety checklist during urgent operations in a global patient population. Ann Surg 251:976–980

    Article  PubMed  Google Scholar 

  26. Peden CJ (2011) Emergency surgery in the elderly patient: a quality improvement approach. Anaesthesia 66:440–445

    Article  PubMed  CAS  Google Scholar 

  27. Wilson I, Paul Barrett M, Sinha A et al (2014) Predictors of in-hospital mortality amongst octogenarians undergoing emergency general surgery: a retrospective cohort study. Int J Surg 12:1157–1161

    Article  PubMed  Google Scholar 

  28. Stupart DA, Watters DA, Guest GD et al (2013) Dedicated emergency theatres improve service delivery and surgeons’ job satisfaction. ANZ J Surg 83:549–553

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, University Hospital Geelong, P.O. Box 281, Geelong, 3220, Australia

    Claire L. Stevens & David A. K. Watters

  2. Victorian Agency for Health Information, Melbourne, Australia

    Christopher Brown

Authors
  1. Claire L. Stevens
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Christopher Brown
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. David A. K. Watters
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Claire L. Stevens.

Annex A: Australian classification of health interventions codes

Annex A: Australian classification of health interventions codes

These codes were including multiple editions (4th–7th) to cover the years included in the study.

Small bowel resection

30375-09 Excision of Meckel’s diverticulum

30405-02 Repair of incisional hernia with resection of strangulated intestine

30405-05 Repair of other abdominal wall hernia with resection of strangulated intestine

30565-00 Resection of small intestine with formation of stoma

30566-00 Resection of small intestine with anastomosis

Colonic resection with anastomosis

30515-03 Ileocolic resection with anastomosis

32003-00 Limited excision of large intestine with anastomosis

32003-01 Right hemicolectomy with anastomosis

32005-00 Subtotal colectomy with anastomosis

32005-01 Extended right hemicolectomy with anastomosis

32006-00 Left hemicolectomy with anastomosis

32024-00 High anterior resection of rectum

Division of adhesions

30378-00 Division of abdominal adhesions

Colonic resection with stoma

30515-05 Ileocolic resection with formation of stoma

32000-00 Limited excision of large intestine with formation of stoma

32000-01 Right hemicolectomy with formation of stoma

32004-00 Subtotal colectomy with formation of stoma

32004-01 Extended right hemicolectomy with formation of stoma

32006-01 Left hemicolectomy with formation of stoma

32009-00 Total colectomy with ileostomy

32030-00 Rectosigmoidectomy with formation of stoma

Other laparotomy

30375-01 Other enterostomy

30375-04 Other colostomy

30375-08 Reduction in intussusception of small intestine

30375-11 Reduction in intussusception of large intestine

30375-15 Gastrotomy with removal of foreign body

30375-17 Reduction in volvulus of large intestine

30375-18 Reduction in volvulus of small intestine

30375-19 Other repair of small intestine

30392-00 Debulking of intra-abdominal lesion

30394-00 Drainage of intra-abdominal abscess, hematoma or cyst

30402-00 Drainage of retroperitoneal abscess, hematoma or cyst

30505-00 Control of bleeding peptic ulcer

30509-00 Control of bleeding peptic ulcer by gastric resection

30512-00 Gastric bypass

30515-00 Gastro-enterostomy

30515-01 Enterocolostomy

30515-02 Enteroenterostomy

30518-00 Partial distal gastrectomy with gastroduodenal anastomosis

30518-01 Partial distal gastrectomy with gastrojejunal anastomosis

30563-02 Repair of parastomal hernia

30564-00 Strictureplasty of small intestine

Exploratory laparotomy

30373-00 Exploratory laparotomy

Debridement and lavage of peritoneal cavity for gross intra peritoneal sepsis

30396-00 Debridement and lavage of peritoneal cavity

Perforated viscous

30375-10 Suture of perforated ulcer

30375-03 Enterotomy of small intestine

30375-24 Suture of small intestine

30375-25 Suture of laceration of large intestine

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Stevens, C.L., Brown, C. & Watters, D.A.K. Measuring Outcomes of Clinical Care: Victorian Emergency Laparotomy Audit Using Quality Investigator. World J Surg 42, 1981–1987 (2018). https://doi.org/10.1007/s00268-017-4418-4

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-017-4418-4

Search

Navigation