From NELA to EPOCH and beyond: enhancing the evidence base for emergency laparotomy.
Around 35,000 patients undergo emergency laparotomy surgery in the UK each year with an in-hospital 30-day mortality estimated as between 11 and 15 %. The recent publication of the First Patient Report of the National Emergency Laparotomy Audit (NELA) has provided a detailed description of individual hospital performance against national standards of care in emergency laparotomy in England and Wales. Although the standards used for audit purposes in NELA are based upon the best currently available evidence, none of the source data derives from randomised controlled studies. This commentary explores the evidence base for the standards evaluated by NELA and highlights recent and forthcoming studies that may substantially contribute to improving the evidence base in this area, thereby improving patient care and strengthening the validity of the NELA audit standards.
University College London Hospital, 235 Euston Rd, London, NW1 2BU UK.
Peter M
PM
Odor
Anaesthesia and Critical Care Research Unit, University Hospitals Southampton NHS Foundation Trust, CE.93 Mailpoint 24, E-Level Centre Block, Southampton, SO16 6YD UK ; Critical Care Research Area, NIHR Respiratory Biomedical Research Unit, University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD UK ; Integrative Physiology and Critical Illness Group, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD UK ; National Institute of Academic Anaesthesia Health Services Research Centre, Royal College of Anaesthetists, London, WC1R 4SG UK.
Michael P W
MP
Grocott
Emergency surgery; Evidence-based medicine; National Emergency Laparotomy Audit