Bowel surgery patients dying because of failures in care
One in 10 patients die within 30 days of undergoing emergency bowel surgery, more than from any other type of high-risk planned surgery, health experts have warned.
More than 30,000 patients undergo an emergency laparotomy, or bowel surgery, every year in NHS hospitals in England and Wales.
The high-risk procedure involves making an incision to operate inside the abdomen to treat life-threatening conditions such as bowel obstruction or perforation.
The National Emergency Laparotomy Audit (NELA) found that 11% of patients who undergo emergency laparotomy die within 30 days of their operation, with the risk up to five times higher than for patients who undergo planned cardiac or cancer surgery.
Its authors highlight a number of particular areas of concern after analysing data on more than 20,000 patients from 192 hospitals, including how closely some were monitored during the night.
While two thirds (68%) of patients admitted to hospital between midnight and 8am were reviewed by a consultant surgeon within 12 hours, only a third (34%) were reviewed within this time if they had been admitted between midday and 6pm.
There was also a wide variation between hospitals, with more than 80% of patients reviewed within 12 hours at one hospital compared to fewer than 40% at 49 other hospitals.
The report said the risk of death and complications that might arise from the surgery should be made and documented beforehand, but this was only done in just over half of patients.
While two thirds (68%) of patients admitted to hospital between midnight and 8am were reviewed by a consultant surgeon within 12 hours, only a third (34%) were reviewed within this time if they had been admitted between midday and 6pm.
There was also a wide variation between hospitals, with more than 80% of patients reviewed within 12 hours at one hospital compared to fewer than 40% at 49 other hospitals.
The report said the risk of death and complications that might arise from the surgery should be made and documented beforehand, but this was only done in just over half of patients.
Those that did were more likely to be allocated appropriate resources and receive care that met standards for best practice.
One in six patients did not arrive in the operating theatre within the recommended time frames - despite the urgent nature of the surgery - and only 60% were admitted to a critical care unit afterwards, when they all should have been.
The audit also found "major variation" in death rates between different patient groups, with one in five (18%) of those over 70 dying in hospital within 30 days of the procedure, compared to 3% of under 50s.
NELA national clinical lead Dr Dave Murray said a "huge variation in clinical management" had been discovered.
"Many hospitals currently meet standards of care for 60-70% of patients, but clinicians, managers and commissioners need to determine why standards are met sometimes and not at others," he said.
President of the Royal College of Surgeons, Clare Marx, said: "We are concerned that mortality remains high for patients that require emergency bowel surgery.
"This audit demonstrates patients are still not accessing a consistently high standard of care from initial assessment through to post-operative care. Such patients need to become a priority for the NHS to improve outcomes for these patients."