Perioperative care of patients undergoing non-elective laparatomy in a district general hospital

Results Data were collected for 43 patients (24 female), 65.1% were aged 60-79 years and 62.3% were ASA 3. Preoperatively 16.3% received level 2 or 3 care. Prior to non-elective laparotomy 23.3% of patients had previous abdominal surgery within the preceding 11 days. Seventy-three percent of surgeries were conducted from 08:00 to 17:59 (5% from 00:00 to 07:59). Consultant surgeon and consultant anaesthetist were present intraoperatively in 80% and 72.5% of cases respectively and in 55% of cases were present together. Immediate post-operative care was as follows: 46.5% post anaesthetic care unit (PACU), 11.6% level 2 (non-PACU) and 41.9% level 3 care. From PACU, a further 15% were transferred to higher level care at 6 hours. Mean length of stay in critical care 3.36 days (range 0.5 15.5 days) and in hospital 24 days (range 3 65 days). The overall incidence of perioperative AKI between day 4 preoperatively and day 7 postoperatively according to AKIN classification and/or serum NGAL was 67.4%. AKIN 3 was reached in 11.6% of patients and 7.0% received haemodiafiltration. AKI was unresolved at day 7 in 11.6%. Post-operative proforma were completed daily for ≥4 days in 37 patients. Within the first 4-7 post-operative days, 14 patients required TPN, 4 patients had an episode of atrial fibrillation, 3 developed pneumonia, 3 congestive cardiac failure and 3 required a further laparotomy. Three patients were dead at 30 days.