Failure in care means bowel surgery patients are dying unnecessarily

Seriously ill patients who have some of the riskiest surgery in medicine are dying unnecessarily because care at too many hospitals is not good enough, an NHS-funded inquiry has found.

More than one in 10 (11%) of those having emergency bowel surgery die within 30 days, according to an audit of the treatment received by 21,000 patients at 192 hospitals in England and Wales.

But the death rate is higher than it should be because of the widespread failure of hospitals to ensure that patients whose lives are under threat – from vital organ failure and an obstructed bowel caused by cancer – get the right care before, during and after their operation.

While some hospitals are good at ensuring that a high proportion of such patients are well looked after, a large minority are not, which reduces people’s chances of survival.

Problems include too few specialist doctors, delays in diagnosis, lack of operating theatres and breaches of hospitals’ duty to give patients with life-threatening infections antibiotics urgently.

The findings are contained in the first-ever clinical audit of what is known as emergency laparotomy. The procedure has a higher mortality rate than any planned surgery adults undergo, including operations for cancer and heart problems.

Some hospitals are doing well. But the national emergency laparotomy audit, undertaken by a group of experts, found survival was compromised because of a series of failings they identified in hospitals’ efforts to ensure that the care of all patients met 12 set standards.

“This is among the riskiest types of surgery. We believe if more hospitals met the standards of care, then the death rates would come down,” said Dr David Murray, a consultant anaesthetist at James Cook hospital in Middlesbrough, who led the team.

The inquiry found that:

  • Although all patients needing emergency bowel surgery should be reviewed by a consultant surgeon within 12 hours of their admission to hospital, 52% are not. At 49 hospitals, fewer than 40% of patients were reviewed within that timeframe. Many patients at risk of death because of sepsis had to wait far longer than they should to receive antibiotics, with 25% waiting more than seven hours.
  • All such patients are also supposed to have their risk of death and complications assessed and documented before surgery. But 44% did not have that. Although the surgery on any patient with a risk of death of 5% or more should involve a consultant surgeon and consultant anaesthetist, a third did not have that in their treatment.
  • Four in 10 patients were not admitted to a critical care unit after their surgery, although all should be.
  • And although provision of extra medical help for older people undergoing surgery should be routine, it was “generally poor”.

Murray said that improving the assessment of all patients’ risk of death, so that they can receive closer supervision, would do more than anything else to increase survival rates.

A spokeswoman for NHS England said: “The variation in existing services underlines how securing the best care for all, not just most, patients will be key for doctors and hospitals as we transform urgent care. This first report sets the baseline from which we now expect services to improve.”

Source The Guardian

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