EGS P19 A new normal or the calm before the storm?. (7th December 2022)

• Record Type: Journal Article
• Authors: Olivier, James; Walsh, Adam; Old, Oliver
• Is Part Of: British journal of surgery. Volume 109(2022)Supplement 9
• Publication Date: 2022-12-07
• Subjects: Surgery -- Periodicals; 617.005
• DOI: 10.1093/bjs/znac404.084
• Languages: English
• ISSNs: 0007-1323

Abstract

Abstract: Background: One of the highest risk factors for morbidity and mortality for general surgery patients is having their surgery in the emergent rather than elective setting. Patients are presenting older, with often complex pathology on a background of multiple medical comorbidities and sometimes extensive surgical history. NELA (national emergency laparotomy audit) and similar projects have looked at assessing and improving upon the management of such cases. These have produced valuable data and improvement in outcomes but there remains a lack of information around the acuity of surgery and the provision of services in response to demand. This study sought to assess the number of NELA cases in hospitals around the UK and compare this to historical data pre-pandemic. Methods: Acute trusts admitting adults under general surgery in England were identified from the online NHS Service Directory. This list was cross referenced with the National Emergency Laparotomy Audit (NELA) list of participating hospitals to check for completeness. This generated 123 acute trusts in England. Contact details for each trust's Freedom of Information (FOI) department was identified from publicly available data on each trust's website. Questions were submitted to the FOI via email for 112 trusts, and online form submission for 11 trusts. Responses were collected for 8 weeks from the date of submission and analysed in Microsoft Excel. Trusts were asked to provide the number of general surgery admissions, inpatient bed numbers and NELA numbers. These were cross-referenced with publicly available data from NHS and NELA websites. Comparisons were made to similar data from 2014. Results: 101 out of 124 trusts responded within the 8-week timeframe. 14, 497 NELA cases were recorded from the national total of 21, 846 stated in the NELA Year 7 report (66.36%). The mean number of beds reported per NELA case was 5.76 (+/- 1.46 CI 95%), with histogram peaking between 3 and 5 beds with a right skew distribution. The mean number of admissions per NELA case was 30.81 (+/- 3.29 CI 95%), with histogram data peaking between 21 and 26 admissions with right skew distribution. A comparison with data from 2014 can be seen below (table 1 ). Table 1 Number of NELA cases (range and median) per quartile of hospital size. Hospitals in England only. Quartile 1 64–364 Beds Quartile 2 371–457 Beds Quartile 3 459–648 Beds Quartile 4 649–1179 Beds NELA Data (2014) Range 25–208 Median 108 Range 67–205 Median 140 Range 71–316 Median 173 Range 119–358 Median 209 EGS Survey (2021) Range 26–197 Median 101.5 Range 8–175 Median 92 Range 23–238 Median 136 Range 109–338 Median 179.5 Conclusions: The Covid-19 pandemic had significant and widespread effects on the provision of services but also to demand. We now know that presentations to hospital reduced as did subsequent inpatient admissions. Our study shows that the number of NELA cases decreased across England and this was independent of hospital size. The largest decrease was seen in quartile 2 followed by quartile 3 representing mid-sized hospitals. Whilst not certain it is likely that this decrease was secondary to the pandemic rather than any change in practices. The results from this study can be used to help hospitals and departments plan their provision of services and training.