Outcomes following emergency laparotomy in Australian public hospitals

Background

International studies reporting outcomes following emergency laparotomies have consistently demonstrated wide inter‐hospital variation and a 30‐day mortality in excess of 10%. The UK then prioritized the funding of the National Emergency Laparotomy Audit. In a prospective Western Australian audit there was minimal inter‐hospital variation and a 6.6% 30‐day mortality. In the absence of any multi‐hospital Australian data the aim of the present study was to compare national administrative data with that previously reported.

Methods

Data on emergency laparotomies performed in Australian public hospitals during 2013/2014 and 2014/2015 were extracted from admitted patient activity and costing data sets collated by the Independent Hospital Pricing Authority. The data sets, containing episode‐level data relating to admitted acute and sub‐acute care patients, included administrative, demographic and clinical information such as patient age, cost, length of stay, in‐hospital mortality, diagnosis and surgical procedure details.

Results

Ninety‐nine public hospitals undertaking at least 50 emergency laparotomies performed 20 388 procedures over the 2 years. The overall in‐hospital mortality was 5.2%. There was a wide interstate and inter‐hospital variation in risk‐adjusted in‐hospital mortality (4.8–6.6% and 0–9.3%, respectively), length of stay (12.5–16.8 days and 5.8–18.9 days, respectively) and intensive care unit admissions (24.5–40.2% and 0–75.7%, respectively).

Conclusion

This data suggest the wide variation in outcomes and care process observed overseas exist in Australia. However, administrative data has considerable limitations and is not a substitute for high quality prospective data. Minimizing variations through prospective quality improvement processes will improve patient outcomes.     

An overview of the endocrinology of skeletal muscle.

Endocrine regulation of the balance between skeletal muscle anabolism and catabolism has been investigated extensively. Factors determining whether hormones exert anabolic or catabolic influences are multifaceted and often unclear. Testosterone, growth hormone, insulin and insulin-like growth factor-I have complex anabolic effects, some of which have only recently been elucidated, and are important regulators of muscle remodeling, whereas glucocorticoids have direct catabolic effects and induce muscle protein loss. The effects of estrogen are poorly understood and warrant further study. We review recent literature and evaluate the hormones driving skeletal muscle anabolism and catabolism, which ultimately dictate the endocrinology and metabolism of skeletal muscle in humans. Understanding hormonal regulation of skeletal muscle remodeling might facilitate development of improved hormone-mediated therapies for muscle wasting conditions.