Managing Acute High-Risk Abdominal Patients: Anesthetic and Intensive Care processes and perspectives

AIM<br/>Primary aim of this quality improvement study is to evaluate the effectiveness of current<br/>treatment protocol following the implementation of the NELA score, management and<br/>outcomes of acute high-risk abdominal (AHA) patients.<br/>Secondary aim is to identify potential areas of improvements.<br/>BACKGROUND<br/>AHA patients constitute a significant portion of emergency hospital admissions and are<br/>associated with high morbidity and mortality. Despite advances in medical treatment and<br/>surgery, complications and mortality remain high. The high mortality rate among AHA<br/>patients, has led to national initiatives. Among those initiatives, are performing surgery<br/>within 6 hours of admission, early access to anesthesiology for perioperative optimization,<br/>and postoperative management in either postoperative recovery unit or ICU.<br/>METHODS<br/>We conducted a qualitative retrospective cohort study. A total of 121 patients were identified<br/>for the period May 2023 to May 2024, of whom 14 were excluded due to irrelevant diagnosis<br/>code. All electronic patient journals were systematically reviewed to identify the variables we<br/>aimed to investigate. The variables included were, preoperative optimization, placement of<br/>central venous catheter, epidural catheter, arterial lines, postoperative management, 30-<br/>and 90-day mortality.<br/>RESULTS<br/>55% of the patients were operated for ileus, 38% for a perforation, and 7% for ischemia.<br/>The NELA score was calculated during surgery for 56% of the patients, while it missed for<br/>44%. For the overall AHA population, the 30-day mortality rate was 17.9%. Considering the<br/>individual groups, 25.8% of ileus patients were admitted to the ICU postoperatively, with a<br/>30-day mortality rate of 23%. For patients with perforation, 50% were admitted to the ICU,<br/>and the 30-day mortality rate was 15%<br/>CONCLUSION AND PERSPECTIVES<br/>AHA patients often have multiple comorbidities. Fast surgical indication and accurate<br/>postoperative triage to either recovery or ICU seems essential in reducing mortality.<br/>Continuous evaluation and optimization of care strategies are necessary to improve<br/>outcomes in this complex patient group.