The Dissemination of Standardised Care Protocol Guidelines for High-Risk Emergency Abdominal Surgery Patients in Denmark.

BACKGROUND

Patients undergoing high-risk emergency abdominal surgery have a high risk of postoperative complications and mortality. International studies suggest that standardised care protocol guidelines may improve outcomes, yet little is known about the dissemination of such guidelines in Denmark.

METHODS

We conducted a nationwide cross-sectional survey among Danish public hospitals treating high-risk emergency abdominal surgical patients. Anaesthesiologists and surgeons responsible for emergency abdominal surgery were invited to report on the presence of joint care protocols, including core components, audit practices and barriers to implementation.

RESULTS

A total of 35 out of 41 eligible departments (85%) responded, representing 20 out of 23 hospitals. Almost all participating hospitals (95%) reported having a joint guideline for high-risk emergency abdominal surgery. The most included components were antibiotics within 3 h (90%), CT scan within 2 h (90%) and intended surgery within 6 h. Only 47% of hospitals showed agreement between surgeons and anaesthesiologists on six or more core components. Audits were conducted in 90% of hospitals, with variations between departments in audit methods and focus. The most frequently reported barriers were limited resources in specialised units, surgical capacity and time constraints.

CONCLUSION

This survey showed that nearly all Danish hospitals treating high-risk emergency abdominal surgical patients reported having a joint guideline endorsed by both the surgical and anaesthesiology departments. Time-critical components aiming at early diagnosis and treatment were the most frequently included core components in the guideline.

EDITORIAL COMMENT: This survey-based report describes how many Danish hospitals have a local guiding document for perioperative anaesthesia and surgical care for cases of high-risk emergency abdominal surgery. The most common components of these across hospitals are described.