71267 - Emergency Laparotomy and No-lap (EL-Nolap) for the old and frail, a 5-year report from an improvement project at Capio S:t Görans Hospital (CStG)

Introduction

Emergency laparotomy patients are often frail and suffer from high postoperative mortality and morbidity rates. In NHS/UK this has been addressed and gradually the National Emergency Laparotomy Audit (NELA) improves quality and safety for this “forgotten group” of patients operated on by the “Cinderella surgeons”. At CStG the EL-pathway has been subject to a continuous cross-functional improvement project since 2018.

Method

A structural pathway lead- and improvement organization was set up with representatives from all involved departments: Emergency, Radiology, Anesthesiology, ASIH and Surgery. Quality-data was analyzed (NELA mirroring), VSM (Value Stream Mapping) was conducted, evidence analyzed and a future EL (and No-lap 2023) perioperative pathway standard was created.

During this period LÖF and the ERAS Society has presented EL guidelines, which was consistent with the new CStG EL-Nolap standard.

The test of the new perioperative standard started 2019 and has been running since and we have created some internal pathway innovations, CHRA and Akut VERAS. Results are followed up automatically in the national SPOR-SWELA database and locally in our Power BI.

Result

2019-2023

Operations n: 959

Mortality(30d) reduction: 75%

Morbidity(Modified CD 3+4) reduction: 50%

No-lap prevalence(2023): 7,5%

Discussion

CStG have shown that you can improve Clinician Reported Outcome Measures (CROM) for EL-Nolap patients with a cross-functional improvement project. Near future demographics will make this kind of organizational learning imperative for the old and frail EL-patients. SKR has set up a NAG (National Working Group), EL-Nolap for the old and frail, with the objective to present Swedish EL-Nolap guidelines spring 2026.