ArticleANZ journal of surgery2025
Cost Effectiveness of a Multidisciplinary Perioperative Protocol for High-Risk Emergency Major Abdominal Surgery in a Regional Victorian Hospital.
Article in ANZ journal of surgery, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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1 citing paper in PubMed.
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Authors and funding
6 authors.
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No grant is acknowledged in the PubMed record.
Abstract
backgroundThe Australian and New Zealand Emergency Laparotomy Audit (ANZELA) was implemented as standard-of-care for Emergency Major Abdominal Surgery (EMAS) at Bendigo Health in September 2021. All EMAS patients undergo routine preoperative risk assessment (RPRA) using the 'National Emergency Laparotomy Audit (NELA) Calculator.' Patients with NELA mortality risk estimates ≥ 10% are considered 'high-risk' and routinely referred to the Intensive Care Unit (ICU) for planned postoperative admission. This study aims to identify whether RPRA and routine ICU referral for high-risk EMAS patients is a cost-effective intervention that improves postoperative outcomes in a rural health service.
methodsThis study is a retrospective audit of high-risk adult patients who underwent EMAS at Bendigo Health between September 2017 and August 2023. Postoperative outcomes and costs were compared before and after implementation of ANZELA. A cost-effectiveness analysis was subsequently conducted to estimate the additional cost required to improve postoperative outcomes and presented as incremental cost-effectiveness ratios (ICERs).
resultsA total of 191 high-risk EMAS patients were identified. The mean postoperative cost of care was AUD$52 338.78, with no significant change post-ANZELA (p = 0.983). Post-ANZELA, there was a 15.3% reduction in the rate of planned ICU admissions (p = 0.026), a 10.9% reduction in the rate of unplanned returns to theatre (p = 0.045), and a 16.83% reduction in the rate of severe postoperative complications (p = 0.03). There was no significant change in postoperative mortality (p = 0.59).
conclusionRPRA and routine ICU referral of high-risk EMAS improve perioperative outcomes without increasing cost-of-care. This protocol may therefore be a cost-effective tool to guide the perioperative care of EMAS patients.
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