{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,23]],"date-time":"2026-03-23T12:56:13Z","timestamp":1774270573396,"version":"3.50.1"},"reference-count":12,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2025,8,22]],"date-time":"2025-08-22T00:00:00Z","timestamp":1755820800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["ANZ Journal of Surgery"],"published-print":{"date-parts":[[2025,10]]},"abstract":"ABSTRACT<\/jats:title>\n \n Background<\/jats:title>\n The Australian and New Zealand Emergency Laparotomy Audit (ANZELA) was implemented as standard\u2010of\u2010care for Emergency Major Abdominal Surgery (EMAS) at Bendigo Health in September 2021. All EMAS patients undergo routine preoperative risk assessment (RPRA) using the \u2018National Emergency Laparotomy Audit (NELA) Calculator.\u2019 Patients with NELA mortality risk estimates \u2265\u200910% are considered \u2018high\u2010risk\u2019 and routinely referred to the Intensive Care Unit (ICU) for planned postoperative admission. This study aims to identify whether RPRA and routine ICU referral for high\u2010risk EMAS patients is a cost\u2010effective intervention that improves postoperative outcomes in a rural health service.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n This study is a retrospective audit of high\u2010risk adult patients who underwent EMAS at Bendigo Health between September 2017 and August 2023. Postoperative outcomes and costs were compared before and after implementation of ANZELA. A cost\u2010effectiveness analysis was subsequently conducted to estimate the additional cost required to improve postoperative outcomes and presented as incremental cost\u2010effectiveness ratios (ICERs).<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n A total of 191 high\u2010risk EMAS patients were identified. The mean postoperative cost of care was AUD$52 338.78, with no significant change post\u2010ANZELA (\n p<\/jats:italic>\n \u2009=\u20090.983). Post\u2010ANZELA, there was a 15.3% reduction in the rate of planned ICU admissions (\n p<\/jats:italic>\n \u2009=\u20090.026), a 10.9% reduction in the rate of unplanned returns to theatre (\n p<\/jats:italic>\n \u2009=\u20090.045), and a 16.83% reduction in the rate of severe postoperative complications (\n p<\/jats:italic>\n \u2009=\u20090.03). There was no significant change in postoperative mortality (\n p<\/jats:italic>\n \u2009=\u20090.59).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n RPRA and routine ICU referral of high\u2010risk EMAS improve perioperative outcomes without increasing cost\u2010of\u2010care. This protocol may therefore be a cost\u2010effective tool to guide the perioperative care of EMAS patients.<\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/ans.70299","type":"journal-article","created":{"date-parts":[[2025,8,22]],"date-time":"2025-08-22T10:21:31Z","timestamp":1755858091000},"page":"2066-2072","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Cost Effectiveness of a Multidisciplinary Perioperative Protocol for High\u2010Risk Emergency Major Abdominal Surgery in a Regional Victorian Hospital"],"prefix":"10.1111","volume":"95","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-9307-3387","authenticated-orcid":false,"given":"Jason Douglas","family":"Cox","sequence":"first","affiliation":[{"name":"Bendigo Health, Monash University School of Rural Health Bendigo Victoria Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ayooluwatomiwa I.","family":"Oloruntoba","sequence":"additional","affiliation":[{"name":"Alfred Health, Monash University Melbourne Victoria Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kate","family":"Booth","sequence":"additional","affiliation":[{"name":"Bendigo Health Bendigo Victoria Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Travis","family":"Murphy","sequence":"additional","affiliation":[{"name":"Bendigo Health Bendigo Victoria Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cameron","family":"Knott","sequence":"additional","affiliation":[{"name":"Alfred Health, Monash University Melbourne Victoria Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chun Hin Angus","family":"Lee","sequence":"additional","affiliation":[{"name":"Bendigo Health Bendigo Victoria Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,8,22]]},"reference":[{"key":"e_1_2_9_2_1","unstructured":"Royal Australasian College of SurgeonsandAustralian and New Zealand College of Anaesthetists \u201cSecond ANZELA\u2010QI Program Summary Report 1 January 2020\u20132031 December 2021. Melbourne \u201d2022."},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1308\/rcsann.2016.0248"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/ans.19260"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/ans.14847"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ccrj.2024.03.003"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.10427"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/anae.13623"},{"key":"e_1_2_9_9_1","unstructured":"\u201cAbout RDA Loddon Mallee Australia: Victoria State Government \u201d(2023) https:\/\/www.rdv.vic.gov.au\/regional\u2010development\u2010australia\/loddon\u2010mallee\/about\u2010us."},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.sla.0000133083.54934.ae"},{"key":"e_1_2_9_11_1","unstructured":"\u201cPowerPerformance Manager \u2010 PPM Australia: PowerHealth Solutions \u201d(2024) https:\/\/www.powerhealthsolutions.com\/ppm."},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1177\/0310057X221105291"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/ans.14164"}],"container-title":["ANZ Journal of Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ans.70299","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,30]],"date-time":"2025-10-30T03:56:58Z","timestamp":1761796618000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/ans.70299"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,22]]},"references-count":12,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2025,10]]}},"alternative-id":["10.1111\/ans.70299"],"URL":"https:\/\/doi.org\/10.1111\/ans.70299","archive":["Portico"],"relation":{},"ISSN":["1445-1433","1445-2197"],"issn-type":[{"value":"1445-1433","type":"print"},{"value":"1445-2197","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,22]]},"assertion":[{"value":"2025-03-21","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-08-05","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-08-22","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}