SP1.1 Comparison of major abdominal emergency surgery outcomes across different organisational models of emergency surgical care: analysis of the UK NELA national database

Aims

Emergency General Surgery (EGS) admissions are high risk and account for 14000 intensive care admissions costing over £88 million per year. This aim of this study is to understand the impact of the emergency general surgery model of care on outcomes from emergency laparotomies.

Methods

Data was obtained from the NELA database. Patients were dichotomised into either EGS hospital or non - EGS Hospital. EGS hospital is defined as a hospital where >5 % of the in-hours emergency laparotomy operating is performed by an emergency general surgeon.

The primary outcome was in – hospital mortality. Secondary outcomes were ITU length of stay and duration of hospital stay. A propensity score weighting approach was used to reduce confounding and selection bias.

Results

115,509 patients were included in the final analysis. Patient characteristics were similar between the 2 groups. Following propensity score weighting, mean SMD reduced from 0.034 to <0.001.

In-hospital mortality was similar (10.8% vs 11.1%, p=0.094), with mean length of stay (16.7 vs 16.1 days, p<0.001) and ITU stay (2.8 vs 2.6 days, p<0.001) persistently longer in patients treated in EGS systems.

Conclusions

There is no significant association between the emergency surgery hospital model of care and in – hospital mortality in emergency laparotomy patients, suggesting the emergency surgery model of care can be utilised effectively without adversely affecting patient outcomes. There is, however, a significant association between the emergency surgery hospital model of care and an increased length of ITU stay and overall hospital stay. Further studies are required to examine the impact of changing models of EGS delivery in the UK.