30-day mortality rate for emergency bowel surgery patients improving despite the pandemic

Published: 10/11/2021

NHS saving millions of pounds with a reduction in the days spent in hospital

An annual national audit led by the Royal College of Anaesthetists (RCoA) around the care of over 21,000 patients before, during and after emergency bowel surgery has shown increased pre-operation patient risk assessments and enhanced patient care to have  reduced the 30-day mortality rate from 11.8% in 2014 to 8.7% in 2020, despite the pressures from the pandemic.

Known as an emergency laparotomy, this surgery is one of the highest risk operations a patient can undergo. The results, which come from data collected across 177 hospitals, also showed a reduction in the number of days spent in hospital, going from 19.2 in 2014 to 15.1 in 2020. The figures show how improved perioperative care for vulnerable patients goes hand in hand with improved patient outcomes, also lessening financial pressures on trusts to the tune of an estimated £30 million annually1.

While the improvements seen in key areas of patient care are very positive, the National Emergency Laparotomy Audit  (NELA) report shows that there are still concerns, for example over the treatment of patients with suspected sepsis with 78.3% not receiving antibiotics within the recommended one hour.

Key data identified in the audit:

  • 85% of patients now receive a preoperative risk assessment up from 56% in the first NELA report in 2015
  • the average number of days spent in hospital has reduced significantly from 19.2 in 2014 to 15.1 in 2020
  • 30-day mortality rate has gone from 11.8% in 2014 to 8.7% in 2020
  • only a fifth of patients (21.7%) who had signs of sepsis on admission received antibiotics within the recommended 60 minutes. A figure that has remained largely stagnant since the data was first recorded in 2015
  • Less than a third (27.1%) of patients over 80, or over 65 and frail, received care from a geriatrician
  • There has been a 18.5% drop in the number of high-risk patients seeing a consultant anaesthetist before surgery going from 94% in 2019 to 75.5% in 2020
  • almost a third of patients (31.6%) needing the most urgent surgery did not get to the operating theatre in the recommended time.

Data from the audit also found that significant variation exists between hospitals and even within the same hospital in the provision of patient care.

Dr Fiona Donald, President of the Royal College of Anaesthetists said:

“The year-on-year improvements in mortality rates and time spent in hospital for patients undergoing emergency bowel surgery are heartening. The data shows clinicians are clearly taking heed of the recommendations outlined in the reports, and steadily improving care across the country. This enhancement in patient outcomes is testament to the commitment and dedication of multiple clinical specialties, doctors, nurses, and other allied health professionals.

“The fact that such improvements happened during the pandemic further highlights the dedication of staff to maintain care for non-COVID patients. It is very reassuring to know that despite the NHS going through arguably the biggest challenge it has ever faced, standards of patient care and outcomes have largely been maintained and in some cases improved.

“While it is positive news, it would be wrong to not also acknowledge, and strive to address areas that could be better. The reports have shown a consistently low rate of patients with suspected sepsis receiving antibiotics within one hour, alongside poor rates of geriatrician input for elderly and frail patients. We must remember that even the slightest delay or disruption to emergency laparotomy patients receiving treatment could have devastating consequences and we hope that the recommendations to improve care can be implemented throughout the healthcare system.

“This report must be shared across the NHS, with hospitals, health boards and Trusts working to maintain the improvements in care, but also taking on board the need to reassess some of their care pathways especially for high-risk and elderly patients, focusing on systematic improvements to ensure improved consistency of care.”

Commissioned by the Healthcare Quality Improvement Partnership as part of the National Clinical Audit Programme, the seventh annual National Emergency Laparotomy Audit report analyses the care received by approximately 21,000 emergency bowel surgery patients treated in NHS hospitals in England and Wales between December 2019 and November 2020. It is based on data collected by teams at 177 hospitals in England and Wales.

 

Reference

  1. Every extra day a patient spends in hospital costs the NHS approximately £350: NHS Improvement Reference costs published 2018.