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Outcomes following emergency laparotomy in Australian public hospitals
Author(s) -
Burmas Melinda,
Aitken R. James,
Broughton Katherine J.
Publication year - 2018
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/ans.14847
Subject(s) - medicine , audit , laparotomy , emergency medicine , intensive care unit , activity based costing , mortality rate , emergency department , public hospital , medical emergency , intensive care medicine , surgery , nursing , business , management , marketing , economics
Background International studies reporting outcomes following emergency laparotomies have consistently demonstrated wide inter‐hospital variation and a 30‐day mortality in excess of 10%. The UK then prioritized the funding of the National Emergency Laparotomy Audit. In a prospective Western Australian audit there was minimal inter‐hospital variation and a 6.6% 30‐day mortality. In the absence of any multi‐hospital Australian data the aim of the present study was to compare national administrative data with that previously reported. Methods Data on emergency laparotomies performed in Australian public hospitals during 2013/2014 and 2014/2015 were extracted from admitted patient activity and costing data sets collated by the Independent Hospital Pricing Authority. The data sets, containing episode‐level data relating to admitted acute and sub‐acute care patients, included administrative, demographic and clinical information such as patient age, cost, length of stay, in‐hospital mortality, diagnosis and surgical procedure details. Results Ninety‐nine public hospitals undertaking at least 50 emergency laparotomies performed 20 388 procedures over the 2 years. The overall in‐hospital mortality was 5.2%. There was a wide interstate and inter‐hospital variation in risk‐adjusted in‐hospital mortality (4.8–6.6% and 0–9.3%, respectively), length of stay (12.5–16.8 days and 5.8–18.9 days, respectively) and intensive care unit admissions (24.5–40.2% and 0–75.7%, respectively). Conclusion This data suggest the wide variation in outcomes and care process observed overseas exist in Australia. However, administrative data has considerable limitations and is not a substitute for high quality prospective data. Minimizing variations through prospective quality improvement processes will improve patient outcomes.