title: A case-control study investigating factors of preoperative delay in emergency laparotomy.
abstract: BACKGROUND
  Emergency laparotomy (EL) is a procedure that puts a strain on healthcare resources and is associated with a significant morbidity and mortality. Despite these implications little improvement in the outcome of patients undergoing this procedure has been made in the UK over the last few decades. A delay in transferring patients to theatre has been shown to negatively affect outcome of EL. A prospective case-control study was carried out to evaluate which preoperative factors may contribute towards a delay in theatre transfer.
  
  
  METHODS
  The time between decision to operate and anaesthetic start time was recorded for all patients undergoing EL between April and September 2013 at Gloucestershire Royal Infirmary. Patient selection criteria were based on the National Emergency Laparotomy Audit guidelines. Patients were divided into two groups depending on whether the transfer to theatre was delayed or not. Binary logistic regression analysis was performed on perioperative factors to determine independent predictors of delay.
  
  
  RESULTS
  A total of 84 EL were included for analyses with 31 classified as delayed. In the delayed group time for theatre transfer was increased at 6.9 vs. 2.3 h (p < 0.005) respectively. Unavailability of emergency theatres due to other cases taking priority was the most frequent cause for delay (n = 24). On binary logistic regression analysis, indication for laparotomy (OR 4.96, CI 1.4-17.6, p < 0.05), patient age (OR 1.04, CI 1.00-1.07, p < 0.04) and presence of a consultant surgeon (OR 0.16, CI 0.03-0.79, p < 0.03) were found to be independent predictors of delay in EL.
  
  
  CONCLUSIONS
  In this study, factors that were associated with a delay in commencing EL were operative indication and patient age whereas the presence of a consultant surgeon made a delay less likely. These findings may highlight points of interest for researchers analysing and auditing the provision of EL in the UK.
authors: Department of General Surgery, Gloucestershire Hospitals NHS Foundation Trust, UK. Electronic address: crispin.schneider.13@ucl.ac.uk.
authors: Crispin
authors: C
authors: Schneider
authors: Department of General Surgery, Gloucestershire Hospitals NHS Foundation Trust, UK.
authors: Laura E
authors: LE
authors: Tyler
authors: Department of General Surgery, Gloucestershire Hospitals NHS Foundation Trust, UK.
authors: Eleanor F
authors: EF
authors: Scull
authors: Department of General Surgery, Gloucestershire Hospitals NHS Foundation Trust, UK.
authors: Belinda J
authors: BJ
authors: Pryle
authors: Department of General Surgery, Gloucestershire Hospitals NHS Foundation Trust, UK.
authors: Hugh
authors: H
authors: Barr
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D007813:Laparotomy / Q000009:adverse effects / Q000401:mortality; D008297:Male; D008875:Middle Aged; D010360:Patient Transfer / Q000592:standards*; D011446:Prospective Studies; D012017:Referral and Consultation; D066231:Surgeons; D013503:Surgery Department, Hospital / Q000592:standards*; D013997:Time Factors; D014218:Triage; D006113:United Kingdom / Q000453:epidemiology; D055815:Young Adult
keywords: Emergency laparotomy; Laparotomy delay; Laparotomy indication; National emergency laparotomy audit; Patient age; Theatre transfer time