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Related Experiment Video

Updated: Mar 31, 2026

Intraoperative Strategy under Complex Vascular Adhesion for Laparoscopic Radical Resection of Bismuth-Corlette Type IIIb Perihilar Cholangiocarcinoma
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Closing the implementation gap: Process outcomes following a structured intraoperative bundle for emergency

Janardhan Baliga1, Philip Iau2,3,4, Paridhi Kavishwar5

  • 1Department of Anaesthesia, Ng Teng Fong General Hospital, Singapore, Pune, Maharashtra, India.

Indian Journal of Anaesthesia
|March 30, 2026
PubMed
Summary

Implementing the Emergency Laparotomy Audit (EMLA) bundle improved consultant care during emergency laparotomy. While it reduced complications, persistent hypothermia requires better temperature management strategies.

Keywords:
Clinical competencefluid therapyhaemodynamic monitoringperioperative carequality improvement

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Area of Science:

  • Surgical Quality Improvement
  • Anesthesiology
  • Critical Care Medicine

Background:

  • Emergency laparotomy carries significant risks.
  • The Emergency Laparotomy Audit (EMLA) in Singapore adapted the UK's NELA audit.
  • This study evaluated EMLA's intraoperative impact in an Asian tertiary hospital.

Purpose of the Study:

  • To assess the impact of a structured intraoperative EMLA bundle.
  • To improve patient outcomes in emergency laparotomy.
  • To evaluate consultant care, goal-directed haemodynamic therapy (GDHT), and normothermia.

Main Methods:

  • Prospective, single-centre quality improvement study.
  • Included 586 adult patients undergoing emergency laparotomy (August 2020 - August 2024).
  • Implemented an intraoperative bundle: consultant care, GDHT for high-risk patients, and normothermia maintenance.

Main Results:

  • Consultant anaesthesiologist presence increased significantly (89.6% to 98.8%).
  • Goal-directed haemodynamic therapy (GDHT) adherence remained high (86.7%-94.6%).
  • Hypothermia (11-16%) correlated with longer LOS and higher ICU admission; 30-day mortality showed no significant change.

Conclusions:

  • The EMLA bundle enhanced consultant coverage and GDHT adherence.
  • Consultant presence showed a potential 42% reduction in medical complications.
  • Persistent hypothermia necessitates improved temperature management protocols.