Implementing Bundle Care in Major Abdominal Emergency Surgery: Long-Term Mortality and Comprehensive Complication
Rune Munch Trangbæk1, Jakob Burcharth2, Ismail Gögenur2
1Department of Surgery, Slagelse Hospital, Fælledvej 11, 4200, Slagelse, Denmark. runemt@gmail.com.
World Journal of Surgery
|September 28, 2022
Summary
Implementing a perioperative care bundle significantly reduced 30-day mortality in major abdominal emergency surgery (MAES). While one-year mortality showed a trend towards improvement, the Comprehensive Complication Index (CCI) did not significantly change.
Area of Science:
- Surgical outcomes research
- Patient safety initiatives
- Critical care medicine
Background:
- Major abdominal emergency surgery (MAES) is associated with high risks of mortality and complications.
- Optimizing perioperative care is crucial for improving outcomes in high-risk surgical patients.
Purpose of the Study:
- To evaluate the impact of a perioperative care bundle on long-term mortality and the Comprehensive Complication Index (CCI) following MAES.
- To assess the effectiveness of the Abdominal Surgery Acute Protocol (ASAP) care bundle.
Main Methods:
- Retrospective cohort study comparing an intervention group (ASAP bundle) with a historical control group.
- Included adult patients undergoing MAES, with prospective data collection for the intervention group.
- Utilized survival analysis and multiple regression for data analysis.
Main Results:
- The 30-day mortality rate decreased significantly from 19.0% in the control group to 6.7% in the intervention group (p=0.003).
- One-year mortality showed a non-significant trend towards reduction (21.7% vs. 28.3%).
- The Comprehensive Complication Index (CCI) was not statistically different between groups (8.7 vs. 21, p=0.932), and length of stay increased by two days.
Conclusions:
- The implemented care bundle (ASAP) effectively reduced 30-day postoperative mortality in MAES.
- The benefits on mortality were observed over time but did not reach statistical significance at one year.
- The care bundle did not significantly impact the Comprehensive Complication Index (CCI).
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