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Insight

Bowel surgery death rate is too high

NELA, the National Emergency Laparotomy Audit, have published their first full report on inpatient care and outcomes of patients undergoing emergency bowel surgery in England and Wales in order to promote quality improvement, and it makes for worrying reading. More than 30,000 patients have to have an emergency laparotomy each year, and the report concludes that around 11% of the patients undergoing these procedures die within 30 days of the surgery being carried out.

The report also found wide variations in care between hospitals. There included concerns regarding the number of procedures being carried out without the appropriate number of consultants in attendance, with just 41% of operations carried out after midnight having the required staff in attendance, and only 61% of operations carried out in the evenings and weekends meeting these criteria.

Many patients were found not to have had a scan which can aid diagnosis and treatment associated with improved survival chances, with only 68% having had a CT scan reported before surgery. There were also delays in getting the patients to theatre within agreed timescales, with one in 6 patients not arriving in theatre within the appropriate timeframe. After the surgery, only 60% of patients were admitted to a critical care unit for observation which is crucial to making sure there was no deterioration after surgery.

The figures are also poor for older people undergoing these procedures, with one in five people over the age of 70 dying within 30 days of surgery.

Jonathan Zimmern says: "This report makes for unhappy reading and it sadly reflects many of the injuries that we see in our offices caused by poor bowel surgery. Hospitals should implement appropriate pathways as recommended by the report to ensure that adequate care is given to these patients, and particularly the elderly. These hospitals need to make sure they are complying with agreed standards of care, and that there is adequate staff provision around the clock. It is worrying to yet again see a report that links poor results to inappropriate staffing levels in the NHS"

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