Anaesthesia
-
Randomized Controlled Trial
Development and validation of a novel tool to estimate peri-operative blood loss.
Surgical blood loss predicts peri-operative outcomes. We have developed and validated Blood Loss Scores to estimate peri-operative blood loss during major abdominal surgery. ⋯ The score, taking into account suction fluid volume and haemoglobin concentration, explained more of the variance in the measured blood loss than the experts' assessment (77% vs 54%, p = 0.05) or the change in haemoglobin concentration (77% vs 11%, p < 0.0001). Addition of the change in haemoglobin concentration improved the estimate for the 24- and 48-h postoperative Blood Loss Scores to explain 78% and 80% of the variance of measured blood loss.
-
Significant recent interest has focussed on improving outcomes after emergency laparotomy. This retrospective database analysis estimated the annual incidence and associated inpatient costs of emergency laparotomy in England. Demographic, process and outcome data were collected for all patients undergoing emergency laparotomy in Brighton for two calendar years (2009-2010). ⋯ We also found that patients > 70 years (46%) had significantly higher 30-day postoperative mortality (18% vs 6%, p < 0.0001), significantly prolonged median (IQR [range]) length of stay (15 (10-26 [1-123]) days vs 12 (7-22 [1-176]) days, p < 0.001) and incurred higher costs (median (IQR [range]) £9667 (6620-15 732 [1920-103 624]) vs £7467 (4975-14 251 [1178-118 060]), p < 0.001). Emergency laparotomy is a common procedure associated with considerable cost, particularly among elderly patients. A National Emergency Laparotomy Database will help provide an evidence base on which to improve clinical outcome and cost efficiency.