PLAIN ENGLISH SUMMARY OF THE BCAE STUDY

Problem

Intestinal emergencies are common and potentially life-threatening. Patients frequently need emergency abdominal surgery, which involves a large cut to access the abdomen called a laparotomy. Emergency laparotomy has a high (10%+) risk of death, and is more dangerous than open-heart surgery. In recent years, a national audit has set high standards of care, leading to better outcomes. Recently, keyhole surgery (laparoscopy) instead of laparotomy has been considered and our early data in Portsmouth Hospitals NHS Trust suggests patients may do better with this approach.

For various reasons, 1 in 3 patients admitted with an intestinal emergency do NOT have a laparotomy. There are currently no documented, evidence-based care pathways providing alternatives to laparotomy, even though the risk of death is 5 times higher. This problem originates from a lack of information on other treatments and their risks. Without this information, it is difficult for surgeons to advise patients and relatives on the merits of other treatments compared to laparotomy. As a result, these patients do not routinely receive the same quality of care. Understanding this group more clearly may result in identifying patients who could in fact have done better with surgical or non-surgical treatments (for example, have infection drained under X-ray or ultrasound) instead of just limited or end of life care.

​

Patient and Public Involvement Priorities

Our PPI representatives identified 3 key needs: patients’ lack of awareness of the real risks of laparotomy, limited information on alternative treatments, and how to communicate this clearly in a high-stress situation.

​

Aim

Therefore, our aim is to find the best care for all patients with an abdominal emergency by:


​

1. Understanding the outcomes for all patients admitted with an intestinal emergency including those who do not have surgery.

2. Identifying patient and admission characteristics of the 4 groups of patients (laparotomy, laparoscopy, non- surgical treatments, and end of life care), in order for surgeons to be better informed when discussing the choices and risks with their patients.

​

Methods 

The study uses large amounts of data that are routinely collected by the hospital as part of patient’s normal care.  The data includes health problems, routine blood tests, vital signs, new diagnoses, procedures and outcomes.  It is from events that have already happened and does not require active patient involvement. The study will collect this data without seeking individual patient consent.  We make patient identity anonymous by using a study number for each set of patient data.  There is no way you could be identified as an individual from the results of the study. We strictly follow Trust Data Protection, IT Security and GDPR Guidelines. 

​

If you would not like your data to be used in the study please go to this page for further information.

​

Dissemination 

This data will be analysed by a health modelling team looking at factors that could predict the best care for these patients. This will result in evidence-based clearer patient information and the development of care pathways that we will share and publish.

Finally, this study will provide evidence to justify a proposed larger multi-centre study to follow, where we intend to further develop and test the four care pathways and help select patients for best care based on individual risk

predicted from their own admission data.