Knife to the skin timing in emergency laparotomies (NELA patients): Are we quick enough?
Published Date: 01st December 2020
Publication Authors: Patnam V, Barter R, Kanwar S
Aim
Definitive source control is pivotal in achieving ideal outcomes in patients undergoing emergency laparotomy. NELA suggests that 84% requiring immediate or urgent surgery arrived in theatre in congruous timeframe but does not comment on Knife to skin timings for absolute source control. We aimed to assess time difference of arrival to theatre and knife to skin, its impact on patient mortality and morbidity.
Methods
100 locked patients data from district general hospital of year 2019 were randomly selected from NELA database. Median time intervals from decision to surgery, time to theatre and knife to skin were evaluated along with patient risk factors.
Results
Median age (50 females and males) was 71 (IQR 54 ‐ 78), and majority of patients had ASA score of 3 with median frailty index of 4. Median time interval from decision to surgery and arrival at theatre was 6.12 hours (IQR 5.02 – 9.30), from theatre arrival and knife to skin was 2.30 hours (IQR 2.15 – 2.45). When these intervals are summed, duration for definitive source control increases drastically and surpass the desired target values, although though median surgery period was 2.18 hours (IQR 1.52‐2.50). A notable number of these had relook surgery and prolonged HDU/ITU admission and recovery.
Conclusion
Pre‐emptive resuscitative measures should start the moment there is a strong suspicion of laparotomy, are prime importance to revive physiological reserves. Although antibiotic administration timings have improved, time to source control still lack due to logistics,infrastructural constraints. Definitive timely intervention is quintessential for ideal outcomes.
Patnam, V; Barter, R; Kanwar, S. (2020). Knife to the skin timing in emergency laparotomies (NELA patients): Are we quick enough?. British Journal of Surgery. 107 (S4), 27