Cargando…

Standardized perioperative management in acute abdominal surgery: Swedish SMASH controlled study

BACKGROUND: Acute high-risk abdominal surgery is common, as are the attendant risks of organ failure, need for intensive care, mortality, or long hospital stay. This study assessed the implementation of standardized management. METHODS: A prospective study of all adults undergoing emergency laparoto...

Descripción completa

Detalles Bibliográficos
Autores principales: Timan, Terje J, Karlsson, Ove, Sernert, Ninni, Prytz, Mattias
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10364510/
https://www.ncbi.nlm.nih.gov/pubmed/37071812
http://dx.doi.org/10.1093/bjs/znad081
_version_ 1785076858952351744
author Timan, Terje J
Karlsson, Ove
Sernert, Ninni
Prytz, Mattias
author_facet Timan, Terje J
Karlsson, Ove
Sernert, Ninni
Prytz, Mattias
author_sort Timan, Terje J
collection PubMed
description BACKGROUND: Acute high-risk abdominal surgery is common, as are the attendant risks of organ failure, need for intensive care, mortality, or long hospital stay. This study assessed the implementation of standardized management. METHODS: A prospective study of all adults undergoing emergency laparotomy over an interval of 42 months (2018–2021) was undertaken; outcomes were compared with those of a retrospective control group. A new standardized clinical protocol was activated for all patients including: prompt bedside physical assessment by the surgeon and anaesthetist, interprofessional communication regarding location of resuscitation, elimination of unnecessary factors that might delay surgery, improved operating theatre competence, regular epidural, enhanced recovery care, and frequent early warning scores. The primary endpoint was 30-day mortality. Secondary endpoints were duration of hospital stay, need for intensive care, and surgical complications. RESULTS: A total of 1344 patients were included, 663 in the control group and 681 in the intervention group. The use of antibiotics increased (81.4 versus 94.7 per cent), and the time from the decision to operate to the start of surgery was reduced (3.80 versus 3.22 h) with use of the new protocol. Fewer anastomoses were performed (22.5 versus 16.8 per cent). The 30-day mortality rate was 14.5 per cent in the historical control group and 10.7 per cent in the intervention group (P = 0.045). The mean duration of hospital (11.9 versus 10.2 days; P = 0.007) and ICU (5.40 versus 3.12 days; P = 0.007) stays was also reduced. The rate of serious surgical complications (grade IIIb–V) was lower (37.6 versus 27.3 per cent; P = <0.001). CONCLUSION: Standardized management protocols improved outcomes after emergency laparotomy.
format Online
Article
Text
id pubmed-10364510
institution National Center for Biotechnology Information
language English
publishDate 2023
publisher Oxford University Press
record_format MEDLINE/PubMed
spelling pubmed-103645102023-07-31 Standardized perioperative management in acute abdominal surgery: Swedish SMASH controlled study Timan, Terje J Karlsson, Ove Sernert, Ninni Prytz, Mattias Br J Surg Original Article BACKGROUND: Acute high-risk abdominal surgery is common, as are the attendant risks of organ failure, need for intensive care, mortality, or long hospital stay. This study assessed the implementation of standardized management. METHODS: A prospective study of all adults undergoing emergency laparotomy over an interval of 42 months (2018–2021) was undertaken; outcomes were compared with those of a retrospective control group. A new standardized clinical protocol was activated for all patients including: prompt bedside physical assessment by the surgeon and anaesthetist, interprofessional communication regarding location of resuscitation, elimination of unnecessary factors that might delay surgery, improved operating theatre competence, regular epidural, enhanced recovery care, and frequent early warning scores. The primary endpoint was 30-day mortality. Secondary endpoints were duration of hospital stay, need for intensive care, and surgical complications. RESULTS: A total of 1344 patients were included, 663 in the control group and 681 in the intervention group. The use of antibiotics increased (81.4 versus 94.7 per cent), and the time from the decision to operate to the start of surgery was reduced (3.80 versus 3.22 h) with use of the new protocol. Fewer anastomoses were performed (22.5 versus 16.8 per cent). The 30-day mortality rate was 14.5 per cent in the historical control group and 10.7 per cent in the intervention group (P = 0.045). The mean duration of hospital (11.9 versus 10.2 days; P = 0.007) and ICU (5.40 versus 3.12 days; P = 0.007) stays was also reduced. The rate of serious surgical complications (grade IIIb–V) was lower (37.6 versus 27.3 per cent; P = <0.001). CONCLUSION: Standardized management protocols improved outcomes after emergency laparotomy. Oxford University Press 2023-04-18 /pmc/articles/PMC10364510/ /pubmed/37071812 http://dx.doi.org/10.1093/bjs/znad081 Text en © The Author(s) 2023. Published by Oxford University Press on behalf of BJS Society Ltd. https://creativecommons.org/licenses/by-nc/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Original Article
Timan, Terje J
Karlsson, Ove
Sernert, Ninni
Prytz, Mattias
Standardized perioperative management in acute abdominal surgery: Swedish SMASH controlled study
title Standardized perioperative management in acute abdominal surgery: Swedish SMASH controlled study
title_full Standardized perioperative management in acute abdominal surgery: Swedish SMASH controlled study
title_fullStr Standardized perioperative management in acute abdominal surgery: Swedish SMASH controlled study
title_full_unstemmed Standardized perioperative management in acute abdominal surgery: Swedish SMASH controlled study
title_short Standardized perioperative management in acute abdominal surgery: Swedish SMASH controlled study
title_sort standardized perioperative management in acute abdominal surgery: swedish smash controlled study
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10364510/
https://www.ncbi.nlm.nih.gov/pubmed/37071812
http://dx.doi.org/10.1093/bjs/znad081
work_keys_str_mv AT timanterjej standardizedperioperativemanagementinacuteabdominalsurgeryswedishsmashcontrolledstudy
AT karlssonove standardizedperioperativemanagementinacuteabdominalsurgeryswedishsmashcontrolledstudy
AT sernertninni standardizedperioperativemanagementinacuteabdominalsurgeryswedishsmashcontrolledstudy
AT prytzmattias standardizedperioperativemanagementinacuteabdominalsurgeryswedishsmashcontrolledstudy