SP1.11 Hospitals offering emergency laparoscopic surgery have improved outcomes

Abstract

Abstract Aims Only 20% of patients requiring emergency surgery in the UK are offered laparoscopic surgery; there is wide variability in uptake of laparoscopic emergency surgery between hospitals, ranging from 0% to over 80% of cases. This study investigated whether hospitals with an advanced laparoscopic culture had improved outcomes. Methods The national NELA database was interrogated to identify patients requiring surgery for adhesional small bowel obstruction; this was selected because it is common (around 25% of cases in NELA) and often amenable to laparoscopic surgery. Hospitals were grouped into quintiles, according to the number of cases attempted by the laparoscopic approach; each group was assessed for length of stay and mortality. Results In 176 acute hospitals, 20597 operations were performed for adhesional SBO. Overall mortality was 6.2%. In the quintile with the lowest rate of laparoscopy, 4% of cases were started laparoscopically, compared with 44% in the highest quintile. In the lowest quintile, 4.8% of patients were discharged within 3 days, compared to 13.8% in the highest quintile; discharge at 7 days was 26% versus 37%. Overall, 30-day mortality in the group with the lowest rate of laparoscopy was 6.9%, compared with 5.4% in hospitals with the highest rate of laparoscopy (p<0.001). Conclusions Hospitals where patients with adhesional SBO are offered laparoscopic emergency surgery demonstrate shorter lengths of stay and a significantly reduced mortality. This may be due to the benefits of the laparoscopic approach; it could also be a surrogate marker for an advanced culture of emergency surgery.