M. E. Gramlick1, J. Hampton1, G. Francis2, M. Holmes1, G. Sullivan1,2, J. Gani1,2, P. Pockney1,2 1John Hunter Hospital,Department Of Surgery,Newcastle, NSW, Australia 2University of Newcastle,School Of Medicine And Public Health,Newcastle, NSW, Australia
Introduction:
There is currently no data to evaluate survival outcomes for patients who require an emergency laparotomy but present to a hospital with no acute general surgical service. Hunter New England Local Health District (HNELHD) in New South Wales, Australia provides health services to a geographical area of 50,882 square miles, and includes many hospitals which do not provide an acute surgical service. This study evaluates the difference in survival outcomes for patients presenting to a hospital with or without acute general surgical services.
Methods:
A retrospective audit was performed on patients who underwent an emergency laparotomy in HNELHD between January 1st 2016 and December 31st 2017. Data was obtained from paper- and electronic-based medical records, and entered in to a REDCap online research database platform. The data was then filtered to look at patients who presented to a hospital with no acute general surgical service, and required transfer to a larger hospital with acute general surgery capability. This group was compared to patients who had presented directly to a hospital with an acute general surgical service. The data was analysed using Fisher’s exact test.
Results:
410 patients were included in the study after excluding patients aged <18 years, or those undergoing non-emergent or diagnostic procedures. 56 (13.6%) of these patients required transfer from a non-surgical to acute surgical hospital prior to their operation. The 30 day mortality of patients requiring inter-hospital transfer was 21.4% versus 7.9% for those directly admitted to an acute surgical hospital (p=0.0056).
Conclusion:
There is a large disadvantage in survival outcomes for patients who require an emergency laparotomy but present in the first instance to a hospital without acute general surgical services. These results highlight the need for further assessment of factors impacting survival outcomes in patients requiring inter-hospital transfer before surgery, in order to facilitate improvements in resource allocation and distribution across wide geographical regions.