BCAE: Better Care for Abdominal Emergencies

Analysing outcomes for all patients with an abdominal emergency, whether they have surgery, an alternative treatment or no treatment.

Problem
Intestinal emergencies are common and potentially life-threatening. Patients frequently need emergency
abdominal surgery, which involves a large cut to access the abdomen called a laparotomy. Emergency
laparotomy has a high (10%+) risk of death, and is more dangerous than open-heart surgery. In recent years, a
national audit has set high standards of care, leading to better outcomes. Recently, keyhole surgery (laparoscopy)
instead of laparotomy has been considered and our early data in Portsmouth Hospitals NHS Trust suggests
patients may do better with this approach.
For various reasons, 1 in 3 patients admitted with an intestinal emergency do NOT have a laparotomy. There are
currently no documented, evidence-based care pathways providing alternatives to laparotomy, even though the
risk of death is 5 times higher. This problem originates from a lack of information on other treatments and their
risks. Without this information, it is difficult for surgeons to advise patients and relatives on the merits of other
treatments compared to laparotomy. As a result, these patients do not routinely receive the same quality of care.
Understanding this group more clearly may result in identifying patients who could in fact have done better with
surgical or non-surgical treatments (for example, have infection drained under X-ray or ultrasound) instead of just
limited or end of life care.
PPI priorities
Our PPI representatives identified 3 key needs: patients’ lack of awareness of the real risks of laparotomy, limited
information on alternative treatments, and how to communicate this clearly in a high-stress situation.
Aim
Therefore, our aim is to find the best care for all patients with an abdominal emergency by:
1. understanding the outcomes for all patients admitted with an intestinal emergency including those who do not
have surgery, and
2. identifying patient and admission characteristics of the 4 groups of patients (laparotomy, laparoscopy, nonsurgical
treatments, and end of life care),
in order for surgeons to be better informed when discussing the choices and risks with their patients.
Methods
To achieve this, we have a wealth of data collected electronically in PHT over 6 years on approximately 2500
patients , giving us a large sample size. Data includes comorbidities, routine blood tests, vital signs, diagnoses,
procedures and outcomes.
This data will be analysed by a health modelling team looking at factors that could predict the best care for these
patients. This will result in evidence-based clearer patient information and the development of care
pathways that we will share and publish.
Finally, this study will provide evidence to justify a proposed larger multi-centre study to follow, where we intend to
further develop and test the four care pathways and help select patients for best care based on individual risk
predicted from their own admission data.