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Trauma Laparotomy in the UK: A Prospective National Service Evaluation

Authors :
Rebecca Badminton
Rebekka Troller
Bryony Roberts
David O’Reilly
Nick Moody
Emma Davies
Michael Thompson
Mihir Chandarana
Gary Maytham
Zane Perkins
Paul Vulliamy
Duncan Bew
Somayyeh Mossadegh
Iain M. Smith
Charles Bull
Michael Smith
Kirsty Challen
Gethin L. Williams
Helen Farrah
Jonathan Jones
Lorcan o Maoileannaigh
Stella Ruth Smith
Disha Mehta
Victoria Pegna
Adam Brooks
Harriet Owen
Anthony Thaventhiran
Ben Stubbs
Anna Sharrock
Kate Hancorn
Tony Sim
Johanna Paterson
Henry Obinna Nnajiuba
Seema Yalamanchili
Anitha Muthusami
David N. Naumann
Ben Griffiths
Ian Bailey
Jo Manson
Michael Wilson
Harsha Kodakadath
Ross Davenport
Maryam Alfa-Wali
Francis Ezidi
Charlotte Thompson
Olga Rutka
Kate Rej. Prior
Christine Hardcastle
Ewen A. Griffiths
Ibrahim Enemosah
Parv Sains
Charlotte Florence
Sam Docherty
Laura Evans
Max Marsden
Giles Bond-Smith
Chris Finnegan
Stavros Gourgiotis
Adam Gowdy
Natesh Shivakumar
Helen R Dorrance
Lewis S. Gall
Alexandra Chesworth
Raimundas Lunevicius
Michael Greenway
Adeel Akhtar
Oliver Harrison
Callum T. Kaye
Mark Winstanley
Lauren Blackburn
Maria Bassett-Davies
Colin Bergin
Stuart McKechnie
Christopher Briggs
Joseph Hardwicke
Daniel McGeown
Charles A. West
Jon Moore
Alexander Bell
Julian Thompson
Paul Farrelly
Amar Kourdouli
Andrea Rossetto
Phillip Pearce
Nicola Lipscombe
Una Cronin
Alice Graham
Rebecca Varley
Elizabeth Vaughan
Jennifer Ross
Esau Moreno-Camacho
Mari-Claire McGuigan
Jack Navein
Emma Stewart Parker
Alan Watts
Ashish Shrestha
Mansoor Khan
Rich Carden
Laura Jayne Watson
Nabeela S. Malik
Nigel Tai
Michael Daley
Tom Cowlam
Source :
Journal of the American College of Surgeons. 233:383-394
Publication Year :
2021
Publisher :
Ovid Technologies (Wolters Kluwer Health), 2021.

Abstract

Background Trauma patients requiring abdominal operation have considerable morbidity and mortality, yet no specific quality indicators are measured in the trauma systems of the UK. The aims of this study were to describe the characteristics and outcomes of patients undergoing emergency abdominal operation and key processes of care. Study Design A prospective multicenter service evaluation was conducted within all of the major trauma centers in the UK. The study was conducted during 6 months beginning in January 2019. Patients of any age undergoing laparotomy or laparoscopy within 24 hours of injury were included. Existing standards for related emergent conditions were used. Results The study included 363 patients from 34 hospitals. The majority were young men with no comorbidities who required operation to control bleeding (51%). More than 90% received attending-delivered care in the emergency department (318 of 363) and operating room (321 of 363). The overall mortality rate was 9%. Patients with blunt trauma had a greater risk of death compared with patients with penetrating injuries (16.6% vs 3.8%; risk ratio 4.3; 95% CI, 2.0 to 9.4). Patients in which the Major Hemorrhage Protocol (MHP) was activated and who received a blood transfusion (n = 154) constituted a high-risk subgroup, accounting for 45% of the study cohort but 97% of deaths and 96% of blood components transfused. The MHP subgroup had expedited timelines from emergency department arrival to knife to skin (MHP: median 119 minutes [interquartile range 64 to 218 minutes] vs no MHP: median 211 minutes [interquartile range 135 to 425 minutes]; p Conclusions The majority of trauma patients requiring emergency abdominal operation received a high standard of expedited care in a maturing national trauma system. Despite this, mortality and resource use among high-risk patients remains considerable.

Details

ISSN :
10727515
Volume :
233
Database :
OpenAIRE
Journal :
Journal of the American College of Surgeons
Accession number :
edsair.doi.dedup.....9f2175941565ed52fadb5a4066409bcb