A groundbreaking study has analyzed the efficacy of a standardized protocol-based care for patients undergoing high-risk acute abdominal surgery, primarily emergency laparotomy. This procedure is frequently required for conditions such as obstructed or perforated bowel, intra-abdominal bleeding, and surgical complications. The study aimed to investigate if such regimented care could minimize mortality and morbidity in both the immediate and prolonged term.
The SMASH Protocol
Developed at the NU-Hospital group in Trollhatten, Sweden, the protocol dubbed as SMASH (Standardised perioperative Management of patients operated with Acute abdominal Surgery in a High-risk setting), incorporates crucial elements like pre-operative communication, prompt assessment, the commencement of antimicrobial therapy, a high level of expertise in the operation room, and a systematic post-operative care approach centered on bedside assessments and monitoring.
Study Design and Outcomes
The study contrasted the outcomes of a prospective intervention group managed according to this protocol with a control group who underwent surgery before the intervention’s implementation. The control group was operated on during 38 months between 2014 and 2017, and the intervention group during 42 months between 2018 and 2021, totaling 1344 patients (681 in the intervention group and 663 in the control group).
The study discovered that 30-day mortality was reduced from 14.5% to 10.7% (p=0.045) and one-year post-operative mortality from 27.8% to 19.7% (p=0.0005) in the intervention group. The duration of stay in the Intensive Care Unit decreased from 5.4 to 3.1 days (p=0.007), and overall hospital stay from 11.9 to 10.2 days (p=0.009). Severe surgical complications were also decreased from 37.6% to 27.3% (p<0.0001).
Implications of the Findings
The outcomes strongly suggest that the standardized care protocol significantly enhances post-operative outcomes, reduces hospital and ICU stays, and results in fewer complications after emergency laparotomy. This study underscores the value of standardized, protocol-based care in improving patient outcomes in high-risk surgical settings.
