{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,14]],"date-time":"2026-03-14T10:15:24Z","timestamp":1773483324687,"version":"3.50.1"},"reference-count":42,"publisher":"Wiley","issue":"7-8","license":[{"start":{"date-parts":[[2025,6,25]],"date-time":"2025-06-25T00:00:00Z","timestamp":1750809600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["ANZ Journal of Surgery"],"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Emergency laparotomy (EL) is associated with high post\u2010operative morbidity. This study aims to evaluate the sustainability of our peri\u2010operative pathway for EL (Emergency Laparotomy Pathway (ELAP)) during the COVID\u201019 pandemic.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This is a single\u2010center retrospective study on patients who underwent EL following ELAP implementation from Jan 2019\u2013Dec 2022. Exclusion criteria were EL for trauma or vascular surgery. The cohort was divided based on the COVID\u201019 pandemic (COVID was defined from 7 Feb 2020\u201325 Apr 2022). Cumulative sum (CUSUM) analysis was used to assess the chronologic performance of ELAP. Our primary outcomes were efficiency outcomes (time to surgery, presence of senior surgeon\/anaesthetist in theatre and post\u2010operative geriatric review). Our secondary outcomes were post\u2010operative complications, major morbidity, and 30\u2010day mortality.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>There were 564 patients (30.5% pre\u2010COVID, 52.1% COVID, 17.4% post\u2010COVID). The median age was 66.0\u2009years, and 57.6% had ASA score \u2265\u20093. The commonest indication for EL was intestinal obstruction (56.9%). Overall major morbidity was 14.0%, and 30\u2010day mortality was 2.8%. CUSUM analysis showed two phases\u2014exploration phase (Case 1\u2013158) and proficiency phase (Case 159\u2013564); an inflection point was noted following the exploration phase, which showed a more sustained performance in achieving post\u2010operative geriatric review and absence of post\u2010operative complications or major morbidity. There was no observed relationship between COVID\u201019 and the performance of ELAP in both efficiency and clinical outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The good performance of ELAP was sustained at 4\u2009years following its initial implementation despite the COVID\u201019 pandemic, which resulted in major disruptions to healthcare delivery.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ans.70234","type":"journal-article","created":{"date-parts":[[2025,6,25]],"date-time":"2025-06-25T08:18:58Z","timestamp":1750839538000},"page":"1421-1432","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Success of a Transdisciplinary Peri\u2010Operative Pathway for Patients Undergoing Emergency Laparotomy During the <scp>COVID<\/scp>\u201019 Pandemic: A <scp>CUSUM<\/scp> Analysis"],"prefix":"10.1111","volume":"95","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9533-801X","authenticated-orcid":false,"given":"Kai Siang","family":"Chan","sequence":"first","affiliation":[{"name":"Department of General Surgery Khoo Teck Puat Hospital  Yishun Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Woan Wui","family":"Lim","sequence":"additional","affiliation":[{"name":"Department of General Surgery Khoo Teck Puat Hospital  Yishun Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jingwen","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of General Surgery Khoo Teck Puat Hospital  Yishun Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yu Jing","family":"Ong","sequence":"additional","affiliation":[{"name":"Department of General Surgery Khoo Teck Puat Hospital  Yishun Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1518-7456","authenticated-orcid":false,"given":"Marc Weijie","family":"Ong","sequence":"additional","affiliation":[{"name":"Department of General Surgery Khoo Teck Puat Hospital  Yishun Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sivaraj","family":"Gunasekaran","sequence":"additional","affiliation":[{"name":"Department of General Surgery Khoo Teck Puat Hospital  Yishun Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jerry Tiong Thye","family":"Goo","sequence":"additional","affiliation":[{"name":"Department of General Surgery Khoo Teck Puat Hospital  Yishun Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,6,25]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2044.2011.07046.x"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamcollsurg.2012.06.004"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/aet487"},{"key":"e_1_2_10_5_1","unstructured":"\u201cNELA Project Team. Fourth Patient Report of the National Emergency Laparotomy Audit (NELA) \u201d2018 https:\/\/www.nela.org.uk\/downloads\/The%20Fourth%20Patient%20Report%20of%20the%20National%20Emergency%20Laparotomy%20Audit%202018%20\u2010%20Full%20Patient%20Report.pdf."},{"key":"e_1_2_10_6_1","unstructured":"\u201cNational Emergency Laparotomy Audit (NELA) Project Team. 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