Making the decision not to proceed to Emergency Laparotomy in the acute general surgical patient - a multi-disciplinary approach?

Aim

To establish who was involved in making the decision not to proceed to emergency laparotomy for emergency general surgery patients with acute pathology.

Methods

Retrospective single site review of all Emergency General Surgery patients admitted over three calendar months. Identification of and further collection of data from electronic patient records for patients that did not proceed to Emergency Laparotomy despite indicative pathology.

Results

A total of 619 emergency general surgical patients were admitted from 1st January to 31st March 2023.

39 (6.3%) patients had an Emergency Laparotomy.

17 (2.7%) patients did not proceed to laparotomy despite pathology that could indicate the need for emergency laparotomy. 100% of these patients has CT imaging to diagnose the pathology.

Of the 17 patients without laparotomy median age of 86 years (range 42 – 91 years) and 12 were female patients.

A consultant surgeon was involved in the decision making not to proceed to laparotomy 100% of all cases.

A consultant in care of the elderly was involved in the decision making for those aged >65 years in 73% of cases (11/15).

Anaesthetic specialists were involved in the decision making in only 18% (3/17) cases.

Intensivists were involved in only one patient’s case.

The patient (when appropriate) and the patients relatives were consulted in the decision making for 88% (15/17).

Conclusion

NELA has clear standards for emergency laparotomy. We believe the decision not to operate is complex and as such advocate multi-disciplinary input and inclusion of patients and relatives wishes.