Impact of routine pre-operative risk assessment on patients undergoing emergency major abdominal surgery in a regional Victorian hospital.

Abstract

Background: Routine preoperative risk assessment (RPRA) using objective risk prediction tools may improve the perioperative outcomes of emergency major abdominal surgery (EMAS). This project aims to identify whether the introduction of RPRA with the 'National Emergency Laparotomy Audit (NELA) Calculator' as standard-of-care for EMAS at a regional Victorian hospital has improved postoperative outcomes, reduced unplanned postoperative critical care unit (CCU) admission rates, and impacted the 'no-lap' rate.

Methods: An audit was performed including all adult general surgery patients who required EMAS at Bendigo Health between September 2017 and August 2022, including those palliated up-front. Patients requiring surgery for uncomplicated appendicitis, cholecystitis, trauma, and diagnostic laparoscopy were excluded. Patient demographics, preoperative NELA score, CCU admission data and postoperative outcomes were collected and compared between patients undergoing surgery before and after the introduction of RPRA.

Results: Six hundred and ninety-one patients were included in the analysis. Median NELA score was 5 (IQR 1.5-11.75). 2.60% of patients were palliated up-front and did not proceed to surgery. Among the 673 operative patients, 30-day mortality was 5.20%. Following the introduction of RPRA there was a significant reduction in the unplanned CCU admission rate, from 9.14% to 3.48% (P = 0.04). There was no change in postoperative mortality, severe complication rate or planned CCU admission rate.

Conclusion: RPRA reduced rate of unplanned CCU admissions. Postoperative mortality and complication rates did not change following introduction of RPRA. RPRA appears useful in guidance of preoperative palliative decision-making, but further study is required to validate its use in this context.