September 28, 2022World Journal of SurgeryOpen Access

Implementing Bundle Care in Major Abdominal Emergency Surgery: Long‐Term Mortality and Comprehensive Complication Index

View Full Paper

Ask AI

Bookmark

Why the study?

Major abdominal emergency surgery has a high risk of postoperative mortality and complications, motivating an evaluation of whether a perioperative care bundle could reduce long-term mortality and complication severity.

Does the implementation of a multidisciplinary perioperative care bundle reduce one-year mortality and complications in adult patients undergoing major abdominal emergency surgery?

Structured PICO

Does the implementation of a multidisciplinary perioperative care bundle reduce one-year mortality and complications in adult patients undergoing major abdominal emergency surgery?

Population

378 adult patients undergoing major abdominal emergency surgery (MAES), excluding re-operations and transferred patients (120 in the intervention cohort and 258 in the historical control cohort).

Intervention

Multidisciplinary perioperative bundle named Abdominal Surgery Acute Protocol (ASAP) covering the entire perioperative course from admission to discharge, including fast-track initiatives and standardised optimised care before, during, and after surgery.

Comparator

Standard care (historical consecutive control cohort from before the bundle implementation).

Outcome

One-year mortality.hard clinical

Implementing a multidisciplinary perioperative care bundle in major abdominal emergency surgery significantly reduced 30-day mortality but did not significantly improve one-year mortality or overall complication rates.

Limitations

Risk of detection bias due to potentially missed complications in electronic health records
Limited sample size to detect differences in the Comprehensive Complication Index (post hoc analysis suggested >1,000 patients needed per arm)
Single-center retrospective design

Implication

Supports perioperative bundles in MAES; leaves open need for RCTs to confirm mortality and CCI effects.

Abstract

BACKGROUND: Major abdominal emergency surgery (MAES) has a high risk of postoperative mortality and a high complication rate. The aim of this study was to evaluate whether the implementation of a perioperative care bundle reduced long-term mortality and the Comprehensive Complication Index (CCI) after MAES. METHODS: This study was a single-centre retrospective cohort study. Data in the intervention group were collected prospectively and compared with a historical cohort from the same centre. It includes adult patients undergoing MAES. We implemented a care bundle under the name Abdominal Surgery Acute Protocol (ASAP). We initiated fast-track initiatives and standardised optimised care in before, during and after surgery. Data were analysed using survival analysis and multiple regression. RESULTS: We included 120 patients in the intervention cohort and 258 in the historical cohort. The one-year mortality rate was 21.7% in the intervention cohort compared to 28.3% in the standard care cohort. Adjusted odds ratio of one-year mortality 0.81 (CI95% 0.41-1.56). The 30-day mortality was lowered from 19.0 to 6.7% (p = 0.003). The CCI in the intervention cohort was 8.7 (IQR 0-34) compared to 21 (IQR 0-36) in the control cohort (p = 0.932) The length of stay increased by two days (p = 0.021). Most cases had 71-80% protocol compliance. CONCLUSION: Implementing bundle care in major abdominal emergency surgery lowered the 30-day postoperative mortality. The difference in mortality was preserved over time although not significant after one year. The changes in the Comprehensive Complication Index were not statistically significant.