22.09.14
RCS warns of huge variation in emergency surgery mortality outcomes
Variations in mortality outcomes from emergency surgery can differ by 38 percentage points from hospital to hospital, a new report from the Royal College of Surgeons warns.
The Emergency Surgery Policy Briefing, released today, quotes figures from a study by the UK Emergency Laparotomy Network that show mortality outcomes following emergency laparotomies varied from 3.6% to 41.7% across 35 hospitals.
The briefing argues for clearer protocols and standards on how patients undergoing emergency surgery should be treated and for the NHS to measure outcomes for patients much more rigorously by publishing audits.
One of the reasons given for the variation in outcomes is a reduction in the number of surgeons available to carry out emergency surgery. The report says: “Advances in surgery have encouraged the development of a workforce which is increasingly focused on delivering surgical care in specialist areas rather than the wider breadth of emergency surgery. Some specialisation is welcome – specialists who focus on particular procedures have helped to reduce mortality rates – but the NHS also needs more generalists who are able to deliver emergency surgical care.”
In addition, one in 10 emergency surgery patients is re-admitted to hospital within a month with complications, a big rise on a decade ago, the report says. This means added pressure on overstretched accident and emergency departments.
The report makes a series of recommendations for improving emergency surgical care. It calls for NHS England to encourage the separation of elective and emergency surgery to reduce delays in treatment. It also says that emergency surgery should be centralised to bigger hospitals to improve and make standards more consistent.
Another suggestion is that A&E training should be reintroduced for all trainee surgeons and that the recommendations of the Taskforce on the European Working Time Directive be implemented as soon as possible.
Professor Chris Moran, NHS England's director for trauma, said: "The increasing numbers of older patients suffering major trauma is not only due to people living longer but also remaining more active and enjoying a better quality of life. The Major Trauma Networks in England have been designed to get patients to the right surgeons in the right hospital as quickly as possible, no matter what their age. The success of the trauma team in Wessex is testament to this.
“Good rehabilitation following trauma is essential and supported by NHS-England. Specialist medical care and rehabilitation for older patients who suffer major trauma has already been introduced in a number of Major Trauma Centres. As a trauma surgeon, I have seen the great difference these specialist have made to patients in my own hospital and, as more of these specialist are trained, we would expect this service to become available throughout the country".
A Department of Health spokesman said: “We know parts of the NHS are under pressure but the vast majority of people are seen and treated quickly. We’re giving the NHS extra support to keep services sustainable year-round and make sure emergency and non-emergency surgery is planned better. In the long-term, we want to reduce demand by looking after people better in the community.”
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