Improving outcomes following emergency laparotomy: aggregation of marginal gains

Emergency laparotomy is a common general surgical emergency procedure carried out worldwide. It carries with it a very high morbidity and mortality, second only to surgery for ruptured aortic artery aneurysm. There has been considerable work done to improve the outcomes following emergency laparotomy worldwide. In the United Kingdom, the National Emergency Laparotomy Audit (NELA) was established in 2014. It aims to improve the quality of care for emergency laparotomy patients by providing high quality comparative data collected nationally. It also highlights key standards in the provision of care. The focus of NELA and other quality improvement projects related to emergency laparotomy is improving every step in the patient pathway. This includes access to diagnostic investigations, consultant care, risk stratification and post-operative care in an appropriate destination. Every small improvement in each step would aggregate to provide a considerable reduction in patient mortality and morbidity, as well as reduction in the healthcare burden to the system. The aim of this review is to discuss some of the significant steps in improving the quality of emergency laparotomy care and the accompanying evidence.