Risk stratification, management and outcomes in emergency general surgical patients in the UK

Introduction The Royal College of Surgeons of England (RCS) published guidance in 2011 setting standards for the management of emergency surgical patients with the aim of reducing surgical mortality. These suggested the presence of a consultant surgeon and anaesthetist, and transfer to a higher level of care postoperatively for all patients deemed high risk. Objective This prospective multi-institutional study sought to evaluate whether adherence to these standards was associated with reduced mortality. Design Data were prospectively collected on all emergency general surgery operations performed in emergency theatres across Merseyside, UK, during a 30-day period in September–October 2011. Patients were risk assessed using P-POSSUM (Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity). High-risk patients were classified as those with a P-POSSUM predicted mortality of ≥10 %, and moderate-risk patients as those with a P-POSSUM predicted mortality of 5–10 %. Results Some 494 procedures were performed on 471 patients. Twenty-four patients (5 %) died within 30 days of surgery. Mortality in the 65 patients identified as high risk was 27 % (14 patients undergoing 17 procedures), with a consultant surgeon present in 46 of 65 high-risk cases (71 %), a consultant anaesthetist in 43 (66 %), and 46 (71 %) cases were admitted to level 2 or 3 care postoperatively. There was no association between adherence to standards and postoperative mortality in either the whole cohort or specifically the high-risk group. Conclusions There is currently incomplete adherence to the national guidelines, but this does not seem to adversely impact postoperative mortality.