SP9.9 Protocolised Care Pathways in Emergency General Surgery: A systematic review and meta-analysis

Abstract

Abstract Background Emergency abdominal surgery is associated with significant post-operative morbidity and mortality. The delivery of standardised pathways in this setting may have the potential to transform clinical care and improve patient outcomes. Methods The OVID SP versions of MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials were searched between January 1950 and October 2022. Comparative studies reporting on care pathways in emergency laparotomy in adult patients were included. Risk of bias was assessed using the ROBINS-I for non-randomised studies and the RoB-2 for randomised controlled trials. Meta-analysis was performed using a random effects model. Results Seventeen studies consisting of 20,927 patients were included, with 12,359 patients undergoing protocolised care pathways and 8,568 patients undergoing standard care pathways. Thirteen unique protocolised pathways were identified, with a median of 8 components (range 6 – 15), with variable compliance of 24-100%. Protocolised care pathways were associated with a shorter hospital stay compared to standard care pathways (SMD -2.028, 95% CI -3.28 – -0.88, p = <0.01). Protocolised care pathways were associated with reduced mortality (OR 0.78, 95% CI 0.71 – 0.86, p<0.00001)) and morbidity (OR 0.80, 95% CI 0.649 – 0.94, p=0.005), including post-operative pneumonia (OR 0.43 95% CI 0.29 – 0.64, p<0.0001) and surgical site infection (OR 0.43, 95% CI 0.29 -0.65, p<0.0001). There were no observed differences in re-operation (OR 1.24, 95% CI 0.72 – 2.16, p=0.44) or readmission rates (OR 1.15, 95% CI 0.83 – 1.59, p=0.41). Discussion Protocolised care pathways in the emergency setting currently lack standardisation, however, despite this are associated with short-term clinical benefits.