• Joel Wen Liang Lau, Janardhan Baliga, Faheem Khan, Ying Xin Teo, Jonathan Ming Jie Yeo, Vincent Zhiwei Yeow, Christine Xia Wu, Stephanie Teo, Tracy Jia Hui Goh, Philip Iau, and Emergency Laparotomy Group.
• Department of Surgery, Ng Teng Fong General Hospital, Singapore.
• Ann Acad Med Singap. 2024 Dec 26; 53 (12): 713723713-723.

IntroductionEmergency laparotomy (EL) is associated with high morbidity and mortality, often exceeding 10%. This study evaluated the impact of the EMergency Laparotomy Audit (EMLA) interdisciplinary perioperative pathway on patient outcomes, hospital costs and length of stay (LOS) within a single centre.MethodA prospective cohort study was conducted from August 2020 to July 2023. The intervention team included specialist clinicians, hospital administrators and an in-hospital quality improvement team. Patients who underwent EL were divided into a pre-intervention control group (n=136) and a post-intervention group (n=293), and an 8-item bundle was implemented. Propensity scoring with a 1:1 matching method was utilised to reduce confounding and selection bias. The primary outcomes examined were LOS, hospitalis-ation costs and surgical morbidity, while secondary outcomes included 30-day mortality and adherence to the intervention protocol.ResultsThe utilisation of the EMLA perioperative care bundle led to a significant reduction in surgical complications (34.8% to 20.6%, P<0.01), a decrease in LOS by 3.3 days (15.4 to 12.1 days, P=0.03) and lower hospitalisation costs (SGD 40,160 to 30,948, P=0.04). Compliance with key interventions also showed improvement. However, there was no difference in 30-day mortality.ConclusionThis study offers insights on how surgical units can implement systemic perioperative changes to improve outcomes for patients undergoing emergency laparotomy.

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