The vast majority of patients who have signs of sepsis infection before high-risk laparotomy surgery are not getting antibiotics fast enough, the Fifth National Emergency Laparotomy Audit has found.
The audit report showed that 10,947 (45%) of the 24,328 patients who underwent an emergency laparotomy during the audit period (1 December 2017 to 30 November 2018) had signs of sepsis; approximately half of which had generalised peritonitis.
Time to antibiotics in patients with sepsis was even poorer than previous years with 80.6% not receiving antibiotics within 1 hour, the audit, covering 179 NHS hospitals in England and Wales, found.
Patients with suspected sepsis on admission waited on average 3.5 hours for the first dose of antibiotics. There has been no improvement in this time since reporting began. In the 21% of patients found to have peritonitis on admission; the average time to antibiotics was 4.5 hours compared with 6 hours in the first audit report.
However, 84% of patients with sepsis reached theatres in the appropriate timeframe, according to the audit report.
Data from the audit found significant variation existed between hospitals and even within the same hospital.
“Only 19% of patients with suspected sepsis received antibiotics in the first hour. This has not improved over 5 years, and is a key area of improvement that must be addressed urgently,” stated one of the audit report’s key messages.
The audit was started in 2013 because studies showed laparotomy is one of the riskiest types of emergency operation. Improvements in care have meant overall mortality rates have dropped from 12% in 2013 to just under 10% in 2018, saving approximately 700 lives a year, the latest audit report notes.