Are return to theatre figures a reliable marker for quality of care in emergency laparotomy? A critical review of 'return to theatre data' at a single site

Abstract text (incl. references and figure legends)

Objectives: The National Emergency laparotomy audit¹ (NELA) collects data to measure outcomes for patients who have undergone emergency laparotomies from over 170 hospitals across England and Wales. A high rate of unplanned return to theatre (URTT) is used as a marker of "less-than-optimal" outcome. It is important to identify the causes for these return rates especially if higher than expected, in order to improve care. This review will look to identify whether NELA data submitted from a single site with higher than expected URTT accurately reflects true unplanned return to theatre for patients who have undergone emergency laparotomies.

Method: Patient level data was reviewed from data submitted to the NELA database from a single site between 2016-2021 and compared with the patient clinical record.

Results: Between 2016-2021, 822 patients were submitted to the NELA database after undergoing emergency laparotomy. 78 were identified as having URTT (9.5% vs national mean 6%). On reviewing patient data, 7 patients did not undergo return to theatre, 4 patients underwent laparotomy for elective complications and 14 underwent planned return. Only 53patients underwent emergency laparotomies with subsequent unplanned returns to theatre (6.4%).

Conclusion: To provide useful information, the submission of data to collective datasets requires accuracy. If an adverse result is reported, the first step is always to critically scrutinise data, especially if data entry is performed by none dedicated staff who may be unfamiliar with precise terminology / criteria. Only after this has been performed should additional actions be considered.

References:

1. NELA. About the Audit: Specific Objectives - The National Institute of Academic Anaesthesia https://www.nela.org.uk/nela_objectives

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