Improving survival from emergency bowel surgery


Southampton will lead a nationwide trial of a treatment approach that could improve survival from emergency bowel surgery by guiding the amount of fluid given to patients during their operations.

A potentially life-saving method for monitoring and treating emergency bowel surgery patients during their operation is being tested in a five year study. The FLO-ELA (FLuid Optimisation in Emergency LAparotomy) trial will involve 7500 patients at 100 centres nationally.

It is being led by Dr Mark Edwards, consultant anaesthetist and researcher in the critical care team of the NIHR Southampton Biomedical Research Centre, a partnership between the University of Southampton and University Hospital Southampton NHS Foundation Trust.

The trial is funded by the National Institute for Health Research Health Technology Assessment Programme. It will compare current care with a protocol guided by a heart monitoring device during and after surgery.

The monitor tracks patients’ blood flow so that exact amounts of fluid can be given when required. This approach has shown promising early results in patients undergoing planned surgery.

Major surgery

Around 30,000 people need emergency bowel surgery each year in the UK. The surgery is performed for many different reasons, including bowel cancer complications or infection.

These are major operations, for patients who tend to be elderly and often have additional health problems. After surgery, patients are usually cared for within intensive care units, but around one in 10 do not survive the immediate effects of surgery.

Maintaining patients’ blood fluid levels and flow is key to successful recovery, but current monitoring methods to guide this such as blood pressure and heart rate may not be reliable. For these patients a fluid protocol using more advanced monitoring methods could improve outcomes.

Improving survival

The trial will use data from emergency bowel surgery collected by the National Emergency Laparotomy Audit (NELA), as well as information from the Office for National Statistics.

NELA is a major ongoing project, commissioned by the Healthcare Quality Improvement Partnership as part of the National Clinical Audit Programme and hosted by the Royal College of Anaesthetists. It has been running since 2012 with the goal of improving the quality of care for these patients.

The trial will compare survival from operations that use this treatment approach during surgery and for six hours afterwards against standard care. 7500 patients over the age of 50 years will be included in the trial.  

The researchers hope this approach will be as successful as for planned bowel operations, where previous studies suggest there may be a 15% reduction in deaths compared to standard care. If so, they plan to get this treatment used as part of standard practice, helping to save lives.

Further information can be found at the study website and by following @FLOELAtrial on Twitter.

Posted on Monday 24 July 2017