Laparoscopy in emergency general surgery (The LEGS Study): NELA database analysis
Badrick, Ellena Parmar, Kathryn L Heywood, N. Malcomson, Lee Renehan, Andrew G Sharma, A
Badrick, Ellena
Parmar, Kathryn L
Heywood, N.
Malcomson, Lee
Renehan, Andrew G
Sharma, A
Citations
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Abstract
Introduction
Guidelines suggest the laparoscopic approach may be useful, safe and feasible in emergency general surgery. Despite this, the UK National Emergency Laparotomy Audit (NELA) rate of fully laparoscopic surgery is only 9% with little increase over time. Our recent UK survey found the use of laparoscopy is influenced by surgeon preference, sub-speciality, patient and operative factors, and suggested NELA database analysis may identify further influencing factors.
Methods
We obtained information from the NELA database (2013 - 2017) and performed logistic regression on pre-operative factors to establish associations with operative approach (open versus any laparoscopic). Factors included sex, age, mode of hospital admission (elective versus non-elective), pre-operative CT scan, NELA risk, ASA score, operative severity, operations in preceding 30 days and grade of operating surgeon.
Results
The cohort comprised 81311 open (51% men, mean age 64.9) and 14151 laparoscopic (51.7% men, mean age 58.3). In a fully adjusted model, all variables other than sex and mode of admission were significantly related to operative approach. Consultant surgeons were more likely to use laparoscopy than other grades (OR of 1.621 (1.517-1.730)). Laparoscopy was less likely in the presence of a pre-operative CT scan (OR 0.648 (95% CI 0.618-0.679)), higher NELA risk, higher ASA grade, and previous operations within the last 30 days (1 prior OR 0.921 (95% CI 0.861-0.985) 2 prior OR 0.784 (95% CI 0.632-0.974)).
Conclusions
We have identified pre-operative factors associated with use of laparoscopy. Further sub-group analysis will stratify by surgical pathology and compare outcomes between laparoscopic and open surgery.
Description
Date
2020
Publisher
Collections
Keywords
Type
Meetings and Proceedings
Citation
Badrick E, Parmar KL, Heywood N, Malcomson L, Renehan AG, Sharma A. Laparoscopy in emergency general surgery (The LEGS Study): NELA database analysis. British Journal of Surgery. 2020;107:49-.