Poor outcomes in patients with sepsis undergoing emergency laparotomy and laparoscopy are attenuated by faster time to care measures

Natthaya Eiamampai; Euan A Ramsay; Roy L Soiza; David A McDonald; Susan J Moug; Phyo K Myint

doi:10.1111/codi.16702

Poor outcomes in patients with sepsis undergoing emergency laparotomy and laparoscopy are attenuated by faster time to care measures

Natthaya Eiamampai, Euan A Ramsay, Roy L Soiza, David A McDonald, Susan J Moug, Phyo K Myint^* (Corresponding Author)

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

1 Citation (Scopus)

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Abstract

AIM: Emergency laparotomy and laparoscopy (EmLap) are amongst the commonest surgical procedures, with high prevalence of sepsis and hence poorer outcomes. However, whether time taken to receive care influences outcomes in patients requiring antibiotics for suspected infection remains largely unexplored. The aim of this work was to determine whether (1) time to care contributes to outcome differences between patients with and without suspected infection and (2) its impact on outcomes only amongst those with suspected infection.

METHOD: Clinical information was retrospectively obtained from the 2017-2018 Emergency Laparotomy and Laparoscopic Scottish Audit (ELLSA). Time to care referred to six temporal variables describing radiological investigation, anaesthetic triage and surgical management. Outcome measures [mortality, readmission, hospital death, postoperative destination and length of stay (LoS)] were compared using adjusted and unadjusted regression analyses to determine whether the outcome differences could be explained by faster or slower time to care.

RESULTS: Amongst 2243 EmLap patients [median age 65 years (interquartile range 51-75 years), 51.1% female], 892 (39.77%) received antibiotics for suspected infection. Although patients with suspected infection had faster time to care (all p ≤ 0.001) and worse outcomes compared with those who did not, outcome differences were not statistically significant when accounted for time (all p > 0.050). Amongst those who received antibiotics, faster time to care was also associated with decreased risk of postoperative intensive care unit (ICU) stay and shorter LoS (all p < 0.050).

CONCLUSION: Worse outcomes associated with infection in EmLap patients were attenuated by faster time to care, which additionally reduced the LoS and ICU stay risk amongst those with suspected infection.

Original language	English
Pages (from-to)	1888-1895
Number of pages	8
Journal	Colorectal Disease
Volume	25
Issue number	9
Early online date	6 Aug 2023
DOIs	https://doi.org/10.1111/codi.16702
Publication status	Published - Sept 2023

Bibliographical note

ACKNOWLEDGEMENTS
NE received the University of Aberdeen Innes Will Endowed Research Scholarship 2022 to carry out the research.

FUNDING INFORMATION
The Emergency Laparotomy and Laparoscopic Scottish Audit (ELLSA) is a Scottish Government initiative supported via the Modernising Patient Pathways Programme (MPPP).

Data Availability Statement

DATA AVAILABILITY STATEMENT
The data that support the findings of this study are available from ELLSA. Restrictions apply to the availability of these data, which were used under license for this study. Data are available from the author(s) with the permission of ELLSA.

Keywords

emergency laparoscopic surgery
emergency laparotomy
emergency surgery
lenght of stay
mortality
sepsis
time to care

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10.1111/codi.16702Licence: CC BY-NC

Eiamampi_etal_CD_Poor_Outcome_IN_VoR
This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes. © 2023 The Authors. Colorectal Disease published by John Wiley & Sons Ltd on behalf of Association of Coloproctology of Great Britain and Ireland.
Final published version, 2.29 MBLicence: CC BY-NC

Cite this

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title = "Poor outcomes in patients with sepsis undergoing emergency laparotomy and laparoscopy are attenuated by faster time to care measures",

abstract = "AIM: Emergency laparotomy and laparoscopy (EmLap) are amongst the commonest surgical procedures, with high prevalence of sepsis and hence poorer outcomes. However, whether time taken to receive care influences outcomes in patients requiring antibiotics for suspected infection remains largely unexplored. The aim of this work was to determine whether (1) time to care contributes to outcome differences between patients with and without suspected infection and (2) its impact on outcomes only amongst those with suspected infection.METHOD: Clinical information was retrospectively obtained from the 2017-2018 Emergency Laparotomy and Laparoscopic Scottish Audit (ELLSA). Time to care referred to six temporal variables describing radiological investigation, anaesthetic triage and surgical management. Outcome measures [mortality, readmission, hospital death, postoperative destination and length of stay (LoS)] were compared using adjusted and unadjusted regression analyses to determine whether the outcome differences could be explained by faster or slower time to care.RESULTS: Amongst 2243 EmLap patients [median age 65 years (interquartile range 51-75 years), 51.1% female], 892 (39.77%) received antibiotics for suspected infection. Although patients with suspected infection had faster time to care (all p ≤ 0.001) and worse outcomes compared with those who did not, outcome differences were not statistically significant when accounted for time (all p > 0.050). Amongst those who received antibiotics, faster time to care was also associated with decreased risk of postoperative intensive care unit (ICU) stay and shorter LoS (all p < 0.050).CONCLUSION: Worse outcomes associated with infection in EmLap patients were attenuated by faster time to care, which additionally reduced the LoS and ICU stay risk amongst those with suspected infection.",

keywords = "emergency laparoscopic surgery, emergency laparotomy, emergency surgery, lenght of stay, mortality, sepsis, time to care",

author = "Natthaya Eiamampai and Ramsay, {Euan A} and Soiza, {Roy L} and McDonald, {David A} and Moug, {Susan J} and Myint, {Phyo K}",

note = "ACKNOWLEDGEMENTS NE received the University of Aberdeen Innes Will Endowed Research Scholarship 2022 to carry out the research. FUNDING INFORMATION The Emergency Laparotomy and Laparoscopic Scottish Audit (ELLSA) is a Scottish Government initiative supported via the Modernising Patient Pathways Programme (MPPP).",

year = "2023",

month = sep,

doi = "10.1111/codi.16702",

language = "English",

volume = "25",

pages = "1888--1895",

journal = "Colorectal Disease",

issn = "1462-8910",

publisher = "WILEY-BLACKWELL",

number = "9",

}

TY - JOUR

T1 - Poor outcomes in patients with sepsis undergoing emergency laparotomy and laparoscopy are attenuated by faster time to care measures

AU - Eiamampai, Natthaya

AU - Ramsay, Euan A

AU - Soiza, Roy L

AU - McDonald, David A

AU - Moug, Susan J

AU - Myint, Phyo K

N1 - ACKNOWLEDGEMENTS NE received the University of Aberdeen Innes Will Endowed Research Scholarship 2022 to carry out the research. FUNDING INFORMATION The Emergency Laparotomy and Laparoscopic Scottish Audit (ELLSA) is a Scottish Government initiative supported via the Modernising Patient Pathways Programme (MPPP).

PY - 2023/9

Y1 - 2023/9

N2 - AIM: Emergency laparotomy and laparoscopy (EmLap) are amongst the commonest surgical procedures, with high prevalence of sepsis and hence poorer outcomes. However, whether time taken to receive care influences outcomes in patients requiring antibiotics for suspected infection remains largely unexplored. The aim of this work was to determine whether (1) time to care contributes to outcome differences between patients with and without suspected infection and (2) its impact on outcomes only amongst those with suspected infection.METHOD: Clinical information was retrospectively obtained from the 2017-2018 Emergency Laparotomy and Laparoscopic Scottish Audit (ELLSA). Time to care referred to six temporal variables describing radiological investigation, anaesthetic triage and surgical management. Outcome measures [mortality, readmission, hospital death, postoperative destination and length of stay (LoS)] were compared using adjusted and unadjusted regression analyses to determine whether the outcome differences could be explained by faster or slower time to care.RESULTS: Amongst 2243 EmLap patients [median age 65 years (interquartile range 51-75 years), 51.1% female], 892 (39.77%) received antibiotics for suspected infection. Although patients with suspected infection had faster time to care (all p ≤ 0.001) and worse outcomes compared with those who did not, outcome differences were not statistically significant when accounted for time (all p > 0.050). Amongst those who received antibiotics, faster time to care was also associated with decreased risk of postoperative intensive care unit (ICU) stay and shorter LoS (all p < 0.050).CONCLUSION: Worse outcomes associated with infection in EmLap patients were attenuated by faster time to care, which additionally reduced the LoS and ICU stay risk amongst those with suspected infection.

AB - AIM: Emergency laparotomy and laparoscopy (EmLap) are amongst the commonest surgical procedures, with high prevalence of sepsis and hence poorer outcomes. However, whether time taken to receive care influences outcomes in patients requiring antibiotics for suspected infection remains largely unexplored. The aim of this work was to determine whether (1) time to care contributes to outcome differences between patients with and without suspected infection and (2) its impact on outcomes only amongst those with suspected infection.METHOD: Clinical information was retrospectively obtained from the 2017-2018 Emergency Laparotomy and Laparoscopic Scottish Audit (ELLSA). Time to care referred to six temporal variables describing radiological investigation, anaesthetic triage and surgical management. Outcome measures [mortality, readmission, hospital death, postoperative destination and length of stay (LoS)] were compared using adjusted and unadjusted regression analyses to determine whether the outcome differences could be explained by faster or slower time to care.RESULTS: Amongst 2243 EmLap patients [median age 65 years (interquartile range 51-75 years), 51.1% female], 892 (39.77%) received antibiotics for suspected infection. Although patients with suspected infection had faster time to care (all p ≤ 0.001) and worse outcomes compared with those who did not, outcome differences were not statistically significant when accounted for time (all p > 0.050). Amongst those who received antibiotics, faster time to care was also associated with decreased risk of postoperative intensive care unit (ICU) stay and shorter LoS (all p < 0.050).CONCLUSION: Worse outcomes associated with infection in EmLap patients were attenuated by faster time to care, which additionally reduced the LoS and ICU stay risk amongst those with suspected infection.

KW - emergency laparoscopic surgery

KW - emergency laparotomy

KW - emergency surgery

KW - lenght of stay

KW - mortality

KW - sepsis

KW - time to care

U2 - 10.1111/codi.16702

DO - 10.1111/codi.16702

M3 - Article

C2 - 37545127

SN - 1462-8910

VL - 25

SP - 1888

EP - 1895

JO - Colorectal Disease

JF - Colorectal Disease

IS - 9

ER -

Poor outcomes in patients with sepsis undergoing emergency laparotomy and laparoscopy are attenuated by faster time to care measures

Abstract

Bibliographical note

Data Availability Statement

Keywords

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