Standardized perioperative management in acute abdominal surgery: Swedish SMASH controlled study

Area of Science:

• Surgery
• Critical Care Medicine
• Health Services Research

Background:

• Acute high-risk abdominal surgery, such as emergency laparotomy, carries significant risks including organ failure, intensive care unit (ICU) admission, mortality, and prolonged hospital stays.
• Standardized management protocols are increasingly recognized as a strategy to mitigate these risks and improve patient outcomes.

Purpose of the Study:

• To assess the impact of implementing a new standardized clinical protocol on outcomes for adult patients undergoing emergency laparotomy.
• To compare outcomes between a group managed with the new protocol and a historical control group.

Main Methods:

• A prospective study included 681 adult patients undergoing emergency laparotomy between 2018 and 2021, compared with 663 retrospective controls.
• The intervention involved a standardized protocol including prompt assessments, improved communication, streamlined surgical processes, enhanced recovery care, and early warning scores.
• Primary endpoint was 30-day mortality; secondary endpoints included hospital and ICU stay duration, and surgical complication rates.

Main Results:

• The intervention group showed a reduction in 30-day mortality (10.7% vs. 14.5%, P=0.045) compared to the control group.
• Hospital stay (10.2 vs. 11.9 days, P=0.007) and ICU stay (3.12 vs. 5.40 days, P=0.007) were significantly reduced in the intervention group.
• Serious surgical complications (grade IIIb-V) decreased from 37.6% to 27.3% (P<0.001) with the standardized protocol.

Conclusions:

• Standardized management protocols demonstrably improve outcomes for patients undergoing emergency laparotomy.
• Implementation of this protocol led to significant reductions in mortality, length of stay, and complication rates.
• This study supports the widespread adoption of standardized protocols in high-risk surgical settings.