The safety and efficacy of laparoscopic ventral mesh rectopexy – Can excellent outcomes be achieved in a district general (2018)

Type of publication:
Conference abstract

Author(s):
*Yassin N.A.; *Orfanos G.; *Farquharson A.L.; *Lacy-Colson J.C.H.

Citation:
Surgical Endoscopy; Dec 2018; vol. 32; Supplement 2, p. S553

Abstract:
Introduction: Laparoscopic ventral mesh rectopexy (VMR) is a popular treatment for symptoms of obstructive defecation in patients suffering with rectal prolapse and rectorectal intussusception. The procedure is technically challenging and may result in serious complications, such as mesh erosions. This study examines the clinical and functional outcomes of patients undergoing VMR in a district general hospital.
Method(s): A retrospective analysis was made of a prospectively maintained database of all laparoscopic VMR procedures. All cases performed by 2 surgeons between February 2012 and June 2016 were included. Length of stay, post-operative complications and functional outcomes were assessed.
Result(s): One hundred patients underwent a laparoscopic VMR procedure during the study period. The mean age was 59.7 years. Nineteen of the patients had external prolapse and 81 had functional bowel symptoms with internal prolapse (rectocele and/or intussusception) as demonstrated on proctography. Pre-operative investigations and pelvic floor multi-disciplinary team (MDT) discussions were performed in all cases. Forty percent of patients had previous pelvic surgery. In the external prolapse group there were 2/19 recurrences (10%). Functional improvement was reported in 96% of the patients. There was only 1 mesh complication (1%).
Conclusion(s): Laparoscopic VMR is an effective and safe procedure for the treatment of symptoms of obstructive defecation. This procedure can be safely performed in the district general hospital setting with excellent clinical and functional outcomes. Thorough preoperative investigations, MDT discussions and standardisation of the surgical technique lead to excellent outcomes.

Critical care usage after major gastrointestinal and liver surgery: a prospective, multicentre observational study (2019)

Type of publication:
Journal article

Author(s):
Claireaux H.A.; Antoniou I.; Dean R.; Davies N.; Trecarten S.; Henderson I.; Holmes C.; Wylie J.; Shuttleworth R.H.; Jindal A.; Hughes F.; Gouda P.; McNamee L.; Fleck R.; Hanrahan M.; Karunakaran P.; Chen J.H.; Sykes M.C.; Sethi R.K.; Suresh S.; Patel P.; Patel M.; Varma R.K.; Mushtaq J.; Gundogan B.; Bolton W.; Mohan M.; Khan T.; Burke J.; Morley R.; Favero N.; Adams R.; Thirumal V.; Kennedy E.D.; Ong K.K.; Tan Y.H.; Gabriel J.; Bakhsh A.; Low J.Y.L.; Yener A.; Paraoan V.; Preece R.; Tilston T.W.; Cumber E.; Dean S.; Ross T.; McCance E.; Amin H.; Satterthwaite L.; Clement K.D.; Gratton R.; Mills E.D.; Chiu S.M.; Hung G.; Rafiq N.M.; Hayes J.D.B.; Robertson K.L.; Dynes K.; Huang H.C.; Assadullah S.; Duncumb J.W.; Moon R.D.C.; Poo S.X.; Mehta J.K.; Joshi K.R.; Callan R.; Norris J.M.; Chilvers N.J.; Keevil H.; Jull P.; Mallick S.; Elf D.; Carr L.; Player C.; Barton E.C.; Martin A.L.; Ratu S.G.; Roberts E.J.; Phan P.N.; Dyal A.R.; Rogers J.E.; Henson A.D.; Reid N.B.; Burke D.; Culleton G.; Lynne S.; Mansoor S.; Brennan C.; Blessed R.; Holloway C.; Hill A.; Goldsmith T.; Mackin S.; Kim S.; Woin E.; Brent G.; Coffin J.; Ziff O.; Momoh Z.; Debenham R.; Ahmed M.; Yong C.S.; Wan J.C.; Copley H.C.; Raut P.; Chaudhry F.I.; Nixon G.; Dorman C.; Tan R.; Kanabar S.; Canning N.; Dolaghan M.; Bell N.; McMenamin M.; Chhabra A.; Duke K.; Turner L.; Patel T.; Chew L.S.; Mirza M.; Lunawat S.; Oremule B.; Ward N.; Khan M.; Tan E.T.; Maclennan D.; McGregor R.J.; Chisholm E.G.; Griffin E.J.; Bell L.; Hughes B.A.; Davies J.; Haq H.; Ahmed H.; Ungcharoen N.; Whacha C.; Thethi R.; Markham R.M.; Lee A.H.Y.; Batt E.; Bullock N.P.; Francescon C.T.; Davies J.E.; Shafiq N.M.; Zhao J.; Vivekanantham S.; Barai I.; Allen J.L.Y.; Marshall D.C.; McIntyre C.J.; Wilson H.C.P.; Ashton A.J.; Lek C.; Behar N.; Davis-Hall M.; Seneviratne N.; Esteve L.; Sirakaya M.; Ali S.; Pope S.; Ahn J.S.; Craig-McQuaide A.; Gatfield W.A.; Leong S.; Demetri A.M.; Kerr A.L.; Rees C.; Loveday J.; Liu S.; Wijesekera M.; Maru D.; Attalla M.; Smith N.; Brown D.; Sritharan P.; Shah A.; Charavanamuttu V.; Heppenstall-Harris G.; Ng K.; Raghvani T.; Rajan N.; Hulley K.; Moody N.; Williams M.; Cotton A.; Sharifpour M.; Lwin K.N.; Bright M.; Chitnis A.R.; Abdelhadi M.; Semana A.D.; Morgan F.; Reid R.; Dickson J.; Anderson L.; McMullan R.; Ahern N.; Asmadi A.; Anderson L.B.; Boon Xuan J.L.; Crozier L.; McAleer S.; Lees D.M.; Adebayo A.A.; Das M.; Amphlett A.H.; Al-Robeye A.; Valli A.; Khangura J.; Winarski A.; Ali A.; Woodward H.; Gouldthrope C.; Turner M.; Sasapu K.; Tonkins M.; Wild J.R.L.; Robinson M.; Hardie J.; Heminway R.; Narramore R.; Ramjeeawon N.; Hibberd A.; Winslow F.; Ho W.; Chong B.F.; Lim K.; Ho S.; Crewdson J.A.; Singagireson S.; Kalra N.; Koumpa F.; Jhala H.; Soon W.C.; Karia M.; Rasiah M.G.; Xylas D.; Gilbert H.; Sundar-Singh M.; Wills J.; Akhtar S.; Patel S.; Hu L.; Brathwaite-Shirley C.; Nayee H.; Amin O.; Rangan T.; Turner E.J.H.; McCrann C.; Shepherd R.; Patel N.; Prest-Smith J.; Auyoung E.; Murtaza A.; Coates A.; Prys-Jones O.; King M.; Gaffney S.; Dewdney C.J.; Nehikhare I.; Lavery J.; Bassett J.; Davies K.; Ahmad K.; Collins A.; Acres M.; Egerton C.; Cheng K.; Chen X.; Chan N.; Sheldon A.; Khan S.; Empey J.; Ingram E.; Malik A.; Johnstone M.; Goodier R.; Shah J.P.; Giles J.E.; Sanders J.A.; McLure S.W.; Pal S.; Rangedara A.; Baker A.N.; Asbjoernsen C.A.; Girling C.; Gray L.; Gauntlett L.; Joyner C.; Qureshi S.; Mogan Y.P.; Ng J.C.K.; Kumar A.N.; Park J.H.; Tan D.; Choo K.P.; Raman K.P.; Buakuma P.; Xiao C.; Govinden S.; Thompson O.D.; Charalambos M.A.; Brown E.; Karsan R.B.; Dogra T.; Bullman L.M.; Dawson P.M.; Frank A.L.; Abid H.; Tung L.; Qureshi U.; Tahmina A.; Matthews B.W.; Harris R.T.; O’Connor A.; Mazan K.; Iqbal S.; Stanger S.A.; Thompson J.D.; Sullivan J.A.L.; Uppal E.; MacAskill A.; Bamgbose F.A.; Neophytou C.; Carroll A.F.; Rookes C.W.; Datta U.; Dhutia A.J.; Rashid S.; Ahmed N.; Lo T.; Bhanderi S.; Blore C.D.; Ahmed S.; Shaheen H.; Abburu S.; Majid S.; Abbas Z.; Talukdar S.S.; Burney L.J.; Patel J.B.; Al-Obaedi O.; Roberts A.W.; Mahboob S.; Singh B.; Sheth S.; Karia P.; Prabhudesai A.; Kow K.; Koysombat K.; Wang S.; Morrison P.; Maheswaran Y.; Keane P.; Copley P.C.; Brewster O.; Xu G.X.; Harries P.; Wall C.; AlMousawi A.; Bonsu S.; Cunha P.; Ward T.; Paul J.; Nadanakumaran K.; Tayeh S.; Holyoak H.; Remedios J.; Theodoropoulou K.; Luhishi A.; Jacob L.; Long F.; Atayi A.; Sarwar S.; Parker O.; Harvey J.; Ross H.; Rampal R.; Thomas G.; Vanmali P.; McGowan C.; Stein J.; Robertson V.; Carthew L.; Teng V.; Fong J.; Street A.N.; Thakker C.E.; O’Reilly D.; Bravo M.; Pizzolato A.; Khokhar H.A.; Ryan M.; Cheskes L.; Carr R.; Salih A.E.; Bassiony S.; Yuen R.; Chrastek D.; Rosen O’Sullivan H.; Amajuoyi A.; Wang A.; Sitta O.; Wye J.; Qamar M.A.; Major C.; Kaushal A.; Morgan C.; Petrarca M.; Allot R.; Verma K.; Dutt S.; Chilima C.P.; Peroos S.; Kosasih S.R.; Chin H.; Ashken L.; Pearse R.J.; O’Loughlin R.A.; Menon A.; Singh K.; Norton J.; Sagar R.; Jathanna N.; Rothwell L.; Watson N.; Harding F.; Dube P.; Khalid H.; Punjabi N.; Sagmeister M.; Gill P.; Shahid S.; Hudson-Phillips S.; George D.; Ashwood J.; Lewis T.; Dhar M.; Sangal P.; Rhema I.A.; Kotecha D.; Afzal Z.; Syeed J.A.; Prakash E.; Jalota P.; Herron J.; Kimani L.; Delport A.; Shukla A.; Agarwal V.; Parthiban S.; Thakur H.; Cymes W.; Rinkoff S.; Turnbull J.A.; Hayat M.; Darr S.; Khan U.; Lim J.; Higgins A.; Lakshmipathy G.; Forte B.; Canning E.; Jaitley A.; Lamont J.; Toner E.; Ghaffar A.; McDowell M.; Salmon D.; O’Carroll O.; Khan A.; Kelly M.E.; Clesham K.; Palmer C.; Lyons R.; Bell A.; Chin R.; Waldron R.M.; Trimble A.; Cox S.E.; Ashfaq U.; Campbell J.; Holliday R.B.S.; McCabe G.; Morris F.; Priestland R.; Vernon O.K.; Ledsam A.; Vaughan R.; Lim D.; Bakewell Z.R.; Hughes R.K.; Koshy R.M.; Jackson H.R.; Narayan P.; Cardwell A.E.; Jubainville C.L.; Arif T.; Elliott L.E.; Gupta V.; Bhaskaran G.; Odeleye A.; Ahmed F.; Shah R.; Pickard J.; Suleman Y.N.; North A.S.; McClymont L.F.; Hussain N.; Ibrahim I.; Ng G.S.; Wong V.; Lim A.E.; Harris L.N.; Tharmachandirar T.; Mittapalli D.; Patel V.; Lakhani M.; Bazeer H.Z.; Narwani V.; Sandhu K.K.; Wingfield L.R.; Gentry S.; Adjei H.; Bhatti M.; Braganza L.; Barnes J.; Mistry S.; Chillarge G.; Stokes S.; Cleere J.; Wadanamby S.; Bucko A.M.; Meek J.; Boxall N.; Heywood E.G.; Wiltshire J.J.; Toh C.; Ward A.E.; Shurovi B.N.; Horth D.; Patel B.Y.; Ali B.; Spencer T.; Axelson T.; Kretzmer L.; Chhina C.; Anandarajah C.; Fautz T.; Horst C.; Thevathasan A.A.; Ng J.Q.; Hirst F.; Brewer C.F.; Logan A.E.; Lockey J.W.; Forrest P.R.; Keelty N.; Wood A.D.; Springford L.R.; Avery P.; Schulz T.M.; Bemand T.P.; Howells L.; Collier H.; Khajuria A.; Tharakan R.G.; Parsons S.; Buchan A.M.; McGalliard R.J.; Mason J.D.; Cundy O.J.; Li N.; Redgrave N.A.; Watson R.P.; Pezas T.P.; Dennis Y.F.; Segall E.; Hameed M.; Lynch A.S.; Chamberlain M.; Peck F.S.; Neo Y.N.; Russell G.; Elseedawy M.; Lee S.; Foster N.L.; Soo Y.H.; Puan L.; Dennis R.; Goradia H.; Qureshi A.; Osman S.; Reeves T.; Dinsmore L.; Marsden M.; Lu Q.; Pitts-Tucker T.; Dunn C.E.; Walford R.A.; Heathcote E.; Martin R.; Pericleous A.; Brzyska K.; Reid K.G.; Williams M.R.; Wetherall N.; McAleer E.; Thomas D.; Kiff R.; Milne S.; Holmes M.J.V.; Bartlett J.; Lucas de Carvalho J.; Bloomfield T.; Tongo F.; Bremner R.H.; Yong N.; Atraszkiewicz B.A.; Mehdi A.; Tahir M.; Sherliker G.X.J.; Tear A.K.; Pandey A.; Broyd A.; Omer H.M.; Raphael M.; Chaudhry W.W.; Shahidi S.; Jawad A.S.; Gill C.K.; Fisher I.H.; Adeleja I.; Clark I.J.; Aidoo-Micah G.E.; Stather P.W.; Salam G.J.; Glover T.E.; Deas G.; Sim N.K.; Obute R.D.; Wynell-Mayow W.M.; Sait M.S.; Mitha N.; de Bernier G.L.; Siddiqui M.; Shaunak R.; Wali A.; Cuthbert G.; Bhudia R.; Webb E.; Shah S.; Ansari N.; Perera M.; Kelly N.; McAllister R.; Stanley G.H.; Keane C.P.; Shatkar V.; MaxwellArmstrong C.; Henderson L.A.; Maple N.; Manson R.; Adams R.D.; Semple E.; Mills M.; Daoub A.; Marsh A.; Ramnarine A.; Hartley J.; Malaj M.; Jewell P.D.; Whatling E.A.; Hitchen N.; Chen M.; Goh B.; Fern J.; Rogers S.; Derbyshire L.; Robertson D.T.; Abuhussein N.; Deekonda P.; Abid A.; Harrison P.L.M.; Aildasani L.; Turley H.; Sherif M.A.; Pandey G.; Filby J.J.; Johnston A.; Burke E.; Mohamud M.; Gohil K.; Tsui A.Y.; Singh R.; Lim S.J.; O’Sullivan K.; McKelvey L.L.; O’Neill S.; Roberts H.F.; Brown F.S.; Cao Y.; Buckle R.T.; Liew Y.; Sii S.; Ventre C.M.; Graham C.J.; Filipescu T.; Yousif A.; Dawar R.; Wright A.; Peters M.; Varley R.; Owczarek S.; Hartley S.; Khattak M.; Iqbal A.; Ali M.; Durrani B.; Narang Y.; Bethell G.S.; Horne L.; Pinto R.; Nicholls K.; Kisyov I.; Torrance H.D.; English W.; Lakhani S.M.; Ashraf S.F.; Venn M.; Elangovan V.; Kazmi Z.; Brecher J.; Sukumar S.; Mastan A.; Mortimer A.; Parker J.; Boyle J.; Elkawafi M.; *Beckett J.; *Mohite A.; *Narain A.; *Mazumdar E.; *Sreh A.; *Hague A.; *Weinberg D.; *Fletcher L.; *Steel M.; Shufflebotham H.; Masood M.; Sinha Y.; Jenvey C.; Kitt H.; Slade R.; Craig A.R.; Deall C.; Reakes T.; Chervenkoff J.; Strange E.; O’Bryan M.; Murkin C.; Joshi D.; Bergara T.; Naqib S.; Wylam D.; Scotcher S.E.; Hewitt C.M.; Stoddart M.T.; Kerai A.; Trist A.J.; Cole S.J.; Knight C.L.; Stevens S.; Cooper G.E.; Ingham R.; Dobson J.; O’Kane A.; Moradzadeh J.; Duffy A.; Henderson C.; Ashraf S.; McLaughin C.; Hoskins T.C.; Reehal R.S.; Bookless L.R.; McLean R.C.; Stone E.J.; Wright E.V.; Abdikadir H.R.; Roberts C.; Spence O.; Srikantharajah M.; Ruiz E.M.; Matthews J.H.; Gardner E.; Hester E.; Naran P.; Simpson R.; Minhas M.; Cornish E.; Semnani S.A.; Rojoa D.; Radotra A.; Eraifej J.; Eparh K.; Smith D.N.E.; Mistry B.D.; Hickling S.L.; Din W.; Liu C.; Mithrakumar P.; Mirdavoudi V.; Rashid M.; Mcgenity C.; Hussain O.; Kadicheeni M.; Gardner H.; Anim-Addo N.; Pearce J.; Aslanyan A.; Ntala C.; Sorah T.; Parkin J.; Alizadeh M.; White A.; Edozie F.; Johnston J.; Kahar A.; Navayogaarajah V.; Patel B.; Carter D.; Khonsari P.; Burgess A.; Kong C.; Ponweera A.; Cody A.; Tan Y.; Ng A.Y.L.; Croall A.; Allan C.; Ng S.; Raghuvir V.; Telfer R.; Greenhalgh A.D.; McKerr C.N.; Edison M.A.; Patel B.A.; Dear K.; Hardy M.R.; Williams P.; Hassan S.; Sajjad U.; O’Neill E.M.; Lopes S.; Healy L.; Jamal N.; Tan S.; Lazenby D.; Husnoo S.B.; Beecroft S.; Sarvanandan T.; Weston C.; Bassam N.; Rabinthiran S.; Hayat U.; Ng L.; Varma D.; Sukkari M.; Mian A.; Omar A.; Kim J.W.; Sellathurai J.; Mahmood J.; O’Connell C.; Bose R.; Heneghan H.; Lalor P.; Matheson J.; Doherty C.; Cullen C.; Cooper D.; Angelov S.; Drislane C.; Smith A.C.D.; Kreibich A.; Palkhi E.; Durr A.; Lotfallah A.; Gold D.; Mckean E.; Dhanji A.; Anilkumar A.; Thacoor A.; Siddiqui Z.H.; Lim S.; Piquet A.; Anderson S.M.; McCormack D.R.; Gulati J.; Ibrahim A.; Murray S.E.; Walsh S.L.; McGrath A.; Ziprin P.; Chua E.Y.; Lou C.N.; Bloomer J.; Paine H.R.; Osei-Kuffour D.; White C.J.; Szczap A.; Gokani S.; Patel K.; Malys M.K.; Reed A.; Torlot G.E.; Cumber E.M.; Charania A.; Ahmad S.; Varma N.; Cheema H.; Austreng L.; Petra H.; Chaudhary M.; Zegeye M.I.; Cheung F.; Coffey D.; Heer R.S.; Singh S.; Seager E.; Cumming S.; Suresh R.S.; Verma S.; Ptacek I.B.; Gwozdz A.M.; Yang T.; Khetarpal A.A.; Shumon S.; Fung T.M.P.; Leung W.; Kwang P.; Chew L.; Loke W.; Curran A.; Chan C.; McGarrigle C.; Mohan K.; Cullen S.; Wong E.; Toale C.; Collins D.; Keane N.; Traynor B.P.; Shanahan D.; Yan A.; Jafree D.J.; Topham C.; Mitrasinovic S.; Omara S.; Bingham G.; Lykoudis P.M.; Miranda B.H.; Whitehurst K.; Kumaran G.; Devabalan Y.; Aziz H.; Shoa M.; Dindyal S.; Yates J.A.; Bernstein I.; Rattan G.; Coulson R.; Stezaker S.; Isaac A.; Salem M.; McBride A.; McFarlane H.; Yow L.; MacDonald J.; Bartlett R.D.; Turaga S.; White U.; Liew W.; Yim N.; Ang A.; Simpson A.; McAuley D.; Craig E.; Murphy L.; Shepherd P.; Kee J.Y.; Abdulmajid A.; Chung A.; Warwick H.L.; Livesey A.; Holton P.; Theodoreson M.D.; Jenkin S.L.; Turner J.; Entwisle J.H.; Marchal S.T.; O’Connor S.; Blege H.K.; Aithie J.M.; Sabine L.M.; Stewart G.E.; Jackson S.; Kishore A.; Lankage C.M.; Acquaah F.; Joyce H.L.; McKevitt K.L.; Coffey C.J.; Fawaz A.S.; Dolbec K.S.; O’Sullivan D.A.; Geraghty J.M.; Lim E.; Bolton L.; FitzPatrick D.; Robinson C.; Ramtoola T.; Collinson S.; Grundy L.; McEnhill P.M.; Harbhajan Singh G.S.; Loughran D.; Golding D.M.; Keeling R.E.; Williams R.P.; Whitham R.D.J.; Yoganathan S.; Nachiappan R.; Egan R.J.; Owasil R.; Kwan M.L.; He A.; Goh R.W.; Bhome R.; Wilson H.; Teoh P.J.; Raji K.; Jayakody N.; Matthams J.; Chong J.; Luk C.Y.; Greig R.J.; Trail M.; Charalambous G.; Rocke A.S.; Gardiner N.; Bulley F.; Warren N.; Brennan E.; Fergurson P.; Wilson R.; Whittingham H.; Brown E.J.; Khanijau R.; Gandhi K.; Morris S.; Boulton A.J.; Chandan N.; Barthorpe A.E.; Maamari R.; Sandhu S.; McCann M.; Higgs L.; Balian V.; Reeder C.; Diaper C.; Sale T.; Ali H.; Archer C.H.; Clarke A.K.; Heskin J.; Hurst P.C.; Farmer J.D.; O’Flynn L.D.; Doan L.; Shuker B.A.; Stott G.D.; Vithanage N.A.; Hoban K.A.; Nesargikar P.N.; Kennedy H.R.; Grossart C.M.; Tan E.S.M.; Roy C.S.D.; Sim P.; Leslie K.E.; Sim D.; Abul M.H.; Cody N.; Tay A.Y.; Woon E.; Sng S.; Mah J.; Robson J.; Shakweh E.; Wing V.C.; Mills H.; Li M.M.; Barrow T.R.; Balaji S.; Jordan H.E.M.; Phillips C.; Naveed H.; Hirani S.; Tai A.; Ratnakumaran R.; Sahathevan A.; Shafi A.M.A.; Seedat M.; Weaver R.; Batho A.; Punj R.; Selvachandran H.; Bhatt N.; Botchey S.; Khonat Z.; Brennan K.; Morrison C.J.; Devlin E.; Linton A.; Galloway E.; McGarvie S.; Ramsay N.; McRobbie H.D.; Whewell H.; Dean W.; Nelaj S.; Eragat M.; Mishra A.; Kane T.; Zuhair M.; Wells M.; Wilkinson D.; Woodcock N.; Sun E.; Aziz N.; Ghaffar M.K.A.; McLean K.A.; Glasbey J.C.; Borakati A.; Brooks T.M.; Chang H.M.; Choi S.M.; Goodson R.; Nielsen M.; Pronin S.; Salloum N.L.; Sewart E.; Vanniasegaram D.; Drake T.M.; Gillies M.A.; Harrison E.M.; Chapman S.J.; Khatri C.; Kong C.Y.; Bath M.F.; Kelly M.; Mitchell H.; Fitzgerald J.E.; Bhangu A.; Nepogodiev D

Citation:
British Journal of Anaesthesia; Jan 2019; vol. 122 (no. 1); p. 42-50

Abstract:
Background: Patient selection for critical care admission must balance patient safety with optimal resource allocation. This study aimed to determine the relationship between critical care admission, and postoperative mortality after abdominal surgery. Method(s): This prespecified secondary analysis of a multicentre, prospective, observational study included consecutive patients enrolled in the DISCOVER study from UK and Republic of Ireland undergoing major gastrointestinal and liver surgery between October and December 2014. The primary outcome was 30-day mortality. Multivariate logistic regression was used to explore associations between critical care admission (planned and unplanned) and mortality, and inter-centre variation in critical care admission after emergency laparotomy. Result(s): Of 4529 patients included, 37.8% (n=1713) underwent planned critical care admissions from theatre Some 3.1% (n=86/2816) admitted to ward-level care subsequently underwent unplanned critical care admission. Overall 30-day mortality was 2.9% (n=133/4519), and the risk-adjusted association between 30-day mortality and critical care admission was higher in unplanned [odds ratio (OR): 8.65, 95% confidence interval (CI): 3.51-19.97) than planned admissions (OR: 2.32, 95% CI: 1.43-3.85). Some 26.7% of patients (n=1210/4529) underwent emergency laparotomies. After adjustment, 49.3% (95% CI: 46.8-51.9%, P<0.001) were predicted to have planned critical care admissions, with 7% (n=10/145) of centres outside the 95% CI. Conclusion(s): After risk adjustment, no 30-day survival benefit was identified for either planned or unplanned postoperative admissions to critical care within this cohort. This likely represents appropriate admission of the highest-risk patients. Planned admissions in selected, intermediate-risk patients may present a strategy to mitigate the risk of unplanned admission. Substantial inter-centre variation exists in planned critical care admissions after emergency laparotomies.

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