Effect of care bundle on emergency laparotomy outcomes

Editor's Note

Hospitals should consider adopting a care bundle approach to improve outcomes for emergency laparotomy patients, this study finds.

In this analysis of 14,809 patients in 28 hospitals in the UK, reduction in unadjusted mortality (from 9.8% to 8.3%) and length of stay (from 20.1 days to 18.9 days) were seen after implementation of a 6-point care bundle. Risk adjusted mortality also fell from 5.5% to 4.5%.

The care bundle included: prompt measurement of blood lactate levels, early review and treatment for sepsis, transfer to the OR within defined time goals after decision to operate, use of goal-directed fluid therapy, postoperative admission to ICU, and multidisciplinary involvement of senior clinicians in the decision and delivery of care.

More marked changes occurred in the second year of the project than before, suggesting that improvement work takes time to establish, the authors say.