Acta Scientific Gastrointestinal Disorders (ASGIS)(ISSN: 2582-1091)

Research Protocol Volume 4 Issue 4

Bowel Surgery Audit in a small County/District Hospital

SA Naqvi*

Ennis General Hospital and University Hospital Limerick, Ireland

*Corresponding Author: SA Naqvi, Ennis General Hospital and University Hospital Limerick, Ireland.

Received: February 22, 2021; Published: March 16, 2021

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Background

   The need of Clinical audit has been increased in the last two decades, as it is required for the accreditation process in every healthcare system. Data collection and analysis are excessively time-consuming in everyday practice. The primary aim of our study was to evaluate the colorectal work at small hospital with out ICU facilities, monitoring of our clinical practice and outcome in difficult circumstances and to evaluate the outcome of colorectal surgeries in a small hospital. The second purpose was to observed mortality rates in this small unit to compare with international standards.

Methods Need to

  Data were evaluated from 49 consecutive colo-rectal operations undergoing elective and emergency surgery over a 4-year period (September 2005–May 2009).

Results

  The observed mortality rate was 2% and morbidity 14% which was significantly in line with the values published in literature.

Discussion

  Our results show that bowel surgery and primary anastomosis is associated with substantial morbidity and mortality. Those patients who have underlying vascular aetiology had a particularly poor outcome. we had 2% of mortality who underwent bowel surgery in small hospital, even when the operation was delayed till the morning list rather doing in the middle of the night. We had conservative management for some patients with adhesion obstruction and it seems justified. We operated as emergency when there were clear signs of strangulation. The majority cases who got complications were general rather than specific to the bowel surgery. There was only one patient who had an anastomotic leak. The low incidence of complications suggests that bowel surgery remains a good training operation in a County/District hospital.

Conclusion

  The study confirms the usefulness of a dedicated database in a surgical audit activity. The overall bowel surgery operations performed in a small hospital with a low 30-day mortality and low in complications in our experience. Total 47 cases (7 complications 14%) [1-10].

Mortality

One Mortality

2%

Morbidity

14%

One bleeding post right hemi

2%

One air leak

2%

One Prolapse of stoma

2%

One anastomotic leak

2%

3 Wound infection

6%

Procedures

Complications

Reversal of Hartman’s Procedure

None

Laparotomy for Adhesions

None

Bleeding DU repair

None

Laparotomy Small Bowel anastomosis

None

Laparotomy division of bowel

adhesions

None

Division of bowel adhesions

Wound infection

Laparotomy bowel resection

None

Anterior resection

None

Right hemicolectomy

None

Colostomy

None

Resection of bowel and stoma

None

Laparotomy and aortic L/N biopsy

None

Perforated DU laparotomy

None

Right hemicolectomy

Hematoma evacuation post right

hemicolectomy

Bleeding Hematoma

formation

Laparotomy for bowel obstruction

None

Right hemicolectomy

None

Anterior Resection

None

Diagnostic Laparotomy for bowel

obstruction

None

Laparotomy Small Bowel Resection

None

Laparotomy resection of bowel

None

Sigmoid colectomy

None

Loop colostomy due to air leak

Anastomotic air leak

Laparotomy and omental biopsy

None

Laparotomy reversal of stoma

None

Anterior resection

Wound infection

Reversal of stoma

None

Laparotomy for perforation DU

None

Right hemicolectomy

None

Stoma, loop ileostomy for bowel

obstruction

None

Laparotomy right hemi-colectomy

None

Laparotomy for obstruction incision

hernia

None

loop colostomy for bowel obstruction

None

Anterior resection

None

Laparotomy bowel resection

None

Colostomy for bowel obstruction

None

Refashion of for stoma due to

prolapsed

Stoma prolapsed

Right hemicolectomy

None

Laparotomy and bowel resection, perforation

None

Laparotomy via RIF wound. Stoma --

--- complication

Wound infection

Right hemicolectomy and formation of

ileostomy

Transferred to tertiary

hospital and died

Right hemicolectomy

None

Right hemicolectomy

None

Laparotomy and Small Bowel resection

None

Laparotomy for appendicular abscess

None

Laparotomy bowel resection loop

ileostomy

None

Laparotomy live L/N biopsies

None

Table 1:

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References

  1. 0% developed an anastomotic leak in a study from Division of Trauma Surgery and Surgical Critical Care, Los Angeles County + University of Southern California Medical Center, Los Angeles, California 90033-4525, USA. Journal of Trauma 70.3 (2011): 603-610.
  2. 3% developed an anastomotic leak in a study from General Surgery Department, Colorectal Unit, Mansoura University Hospital, Mansoura, Egypt. Journal of Gastrointestinal Surgery 15.1 (2011): 137-144.
  3. Anastomotic leak rate (0% vs 5%) in a study from Department of Surgery, Wake Forest University, Winston-Salem, North Carolina 27157, USA. American Surgery6 (2007): 606-609; discussion 609-610.
  4. Anastomotic leak rate was 16.6% in a study from Department of Surgery, University of L'Aquila, Coppito, L'Aquila, Italy. Journal of Gastrointestinal Surgery (2011).
  5. Anastomotic leak/abscess (n=40, 45%) in a study from Department of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland, Ohio. USA Colorectal Disease (2011).
  6. Anastomotic leak 3.9 % in a study from Department of Surgery, Salisbury District Hospital, Salisbury, Wilts, UK. Diseases of the Colon and Rectum 5 (2005): 1021-1026.
  7. Anastomotic leak rate of 2.9% Department of Surgery, North Tyneside General Hospital, North Shields, UK British Journal of Surgery9 (2010): 1416-1430.
  8. Anastomotic leaks post-operatively 2.9% in a study from Department of Surgery, Royal Hampshire County Hospital, Winchester, Hampshire SO22 5DG, UK. Journal of Minimal Access Surgery 2 (2008): 39-43.
  9. The mortality associated with an anastamotic leak in this series was 5% St Thomas' Hospital, London, UK. Colorectal Disease6 (2008): 587-592.
  10. Overall mortality in this series was 27%. Department of Colorectal Surgery, Royal Liverpool University Hospital, Prescot Street, Liverpool L7 8XP, UK. International Journal of Colorectal Disease 3 (2011): 313-320.
×

Citation

Citation: SA Naqvi. “Bowel Surgery Audit in a small County/District Hospital". Acta Scientific Gastrointestinal Disorders 4.4 (2021): 28-30.




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Acceptance to publication20-30 days

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