SP1.10 Predicting unplanned readmissions after emergency laparotomy

Abstract

Abstract Aims St James’s University Hospital in Leeds performs the highest number of emergency laparotomies in the UK. This operation remains one of the highest risk surgical procedures but little is known about the patient journey after discharge from hospital. This service evaluation aimed to assess the rate of unplanned readmissions after discharge, and how to predict those at higher risk of readmission, to inform the implementation of a specialist emergency laparotomy follow-up clinic. Methods The Leeds NELA data were used to collate the clinical details of all patients who underwent an emergency laparotomy between 1st October 2021 – 1st October 2022. The local electronic patient record was searched to identify those who were readmitted within 30 days of discharge. A univariate analysis determined the factors which most accurately predict the risk of readmission. Results The clinical details of 343 patients were analysed, of whom 318 survived to discharge. There were 41 unplanned readmissions to hospital within 30 days of discharge (13%). The most frequent reasons for unplanned readmission were sepsis, wound infection, post-operative pain, high-output stoma and acute kidney injury. Frailty score (OR 1.276; CI 1.031-1.579; p=0.025) and ASA score (OR 1.803; CI 1.218-2.669; p=0.003) were statistically significant predictors of readmission after emergency laparotomy. Conclusions St James’s University Hospital employs two dedicated NELA nurses, and has implemented a weekly outpatient follow-up clinic for patients who have been discharged after emergency laparotomy. The availability of clinic appointments should be prioritised for frail and comorbid patients to enhance the patient’s postoperative journey.