Work

Factors associated with adverse events after emergency laparotomy in Cape Town, South Africa: Identifying opportunities for quality improvement

Year: 2016

Type: article

Abstract: Background: Surgical outcomes research is limited in areas of the world with the greatest unmet surgical need and likely greatest variation in outcomes.Measurement alone may improve outcomes-the so-called Hawthorne effect.The purpose of this multi-center cohort study was to identify factors that are both feasible to collect and are associated with a major adverse event following a targeted procedure in Cape Town, South Africa.Methods: A collaborative of four acute care surgical units was formed to develop a dataset with minimal data burden describing outcomes following an emergency exploratory laparotomy during a 3-month period (February-April 2015).Controlling for patient, problem, provider, procedure and process predictors, multivariate models were built to identify risk factors for a major adverse event and higher resource use following surgery in our collaborative.Results: The outcomes of 450 exploratory laparotomies from the four participating hospitals were audited, 319 (70.9%) were for non-trauma and 131 (29.1%) were for trauma.The major adverse event rate was 15.7% (95% CI 12.6 -19.4).In the multivariate analysis, factors associated with the primary outcome included age, American Society of Anesthesia score of greater than 2, bowel resection, pre-operative CT scan and a non-therapeutic laparotomy.A major adverse event was associated with all three outcomes assessing increased resource utilisation.Conclusion: This study supports the comparative outcome assessment of a high volume or high risk procedure as a proxy for measuring the quality of care provided in a surgical collaborative.Such an exercise can identify opportunities for quality improvement.Auditing the outcomes of all operations at a hospital is difficult.Choosing one or two operations as proxies for the quality of all surgical care provided has been recently proposed [1].We chose to study Emergency Laparotomy, (EL) recently declared by the The Lancet Commission on Global Surgery to be a, 'Bellwether procedure', or one that all district hospitals should be able to provide safely [9].Specifically, we aimed to identify factors that are both feasible to collect and are associated with a major adverse event after emergency laparotomy in Cape Town, South Africa.We hypothesized that a major adverse event was further associated with increased resource utilisation.

Source: Global Surgery

DOI: 10.15761/gos.1000128