Mortality after emergency abdominal surgery in a non‐metropolitan Australian centre

Tocaciu, Shreya; Thiagarajan, Jayaraman J.; Maddern, Guy J.; Wichmann, Matthias W.

doi:10.1111/ajr.12428

Cited by 12 publications

(19 citation statements)

References 20 publications

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“…The 0% post‐operative mortality reported here confirms the safety and efficiency of emergency surgery performed in the rural setting. The 0% mortality rate observed in this prospective study also verifies the previously reported low mortality rate in a retrospective study …”

Section: Discussionsupporting

confidence: 91%

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Rural Emergency Laparotomy Audit

Watson

Maddern

Mudalige

et al. 2019

ANZ Journal of Surgery

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Background: Emergency laparoscopy/laparotomy is associated with high levels of mortality. The aim of this study was to determine whether outcomes following emergency laparoscopy/ laparotomy in rural and regional South Australian hospitals were comparable to those reported in the National Emergency Laparotomy Audit and Perth Emergency Laparotomy Audit. Methods: A prospective multicentre audit of patients who undergo emergency laparoscopy/laparotomy. Participating hospitals included Mount Gambier and Districts Health Service, Whyalla Hospital and Riverland General Hospital. Inclusion and exclusion criteria were identical to the National Emergency Laparotomy Audit. A modified dataset for patients was collected if patients were up-transferred to another hospital prior to operative management. Data collected included patient demographics, operative management, adherence to processes of care and outcomes. Results: Data were collected for a total of 58 cases. Fifty-one of these had emergency laparoscopy/laparotomy in a rural or regional hospital and seven were transferred in the preoperative period. The median Portsmouth-Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity predicted 30-day post-operative mortality was 3.5%. One hundred percent of patients (51 out of 51) had a consultant anaesthetist and surgeon present in the operating theatre. There were no deaths reported within the 30-day postoperative period. Conclusion: Outcomes following emergency laparoscopy/laparotomy in rural and regional South Australian hospitals are comparable to those reported in the National Emergency Laparotomy Audit and Perth Emergency Laparotomy Audit.

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Section: Discussionsupporting

confidence: 91%

“…Throughout the audit period, NELA has driven quality improvement with a reduction in mean length of stay and 30‐day post‐operative mortality rate . The success of NELA has stimulated both retrospective and prospective work in Australia, reporting 30‐day post‐operative mortality rates ranging from 3.8% to 9.7% …”

Section: Introductionmentioning

confidence: 99%

Rural Emergency Laparotomy Audit

Watson

Maddern

Mudalige

et al. 2019

ANZ Journal of Surgery

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“…This is considered to lead to multiple organ failure and acute circulatory failure. In abdominal emergencies requiring surgery, the frequency of lower gastrointestinal perforation is not particularly high [13,14]. Identification of prognostic factors to improve survival rates for this pathology has long been a priority, due to the high mortality rate [15][16][17].…”

Section: Discussionmentioning

confidence: 99%

Low psoas muscle index is a poor prognostic factor for lower gastrointestinal perforation: a single-center retrospective cohort study

Kayano

Nomura

Abe

et al. 2019

Preprint

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Background Various body composition indices have been reported as prognostic factors for different cancers. However, whether body composition affects prognosis after lower gastrointestinal tract perforation requiring emergency surgery and multidisciplinary treatment has not been clarified. This study examined whether body composition evaluations that can be measured easily and quickly from computed tomography (CT) are useful for predicting prognosis. Methods Subjects comprised 64 patients diagnosed with perforation at final diagnosis after emergency surgery for a preoperative diagnosis of lower gastrointestinal tract perforation and penetration. They were divided into a survival group and a non-survival (in-hospital mortality) group and compared. Body composition indices (psoas muscle index (PMI); psoas muscle attenuation (PMA); subcutaneous adipose tissue index (SATI); visceral adipose tissue index (VATI); visceral-to-subcutaneous fat area ratio (VSR)) were measured from preoperative CT. Cross-sectional psoas muscle area at the level of the 3rd lumbar vertebra was quantified. Optimal cut-off values were calculated using receiver operating characteristic curve analysis. Poor prognostic factors were investigated from multivariate logistic regression analyses that included patient factors, perioperative factors, intraoperative factors, and body composition indices as explanatory variables. Results The cause of perforation was malignant disease in 12 cases (18.7%), and benign disease in 52 cases (81.2%). The most common cause was diverticulum of the large intestine. Emergency surgery for the 64 patients led to survival in 52 patients and death in 12 patients. On multivariate logistic regression analysis, independent predictors of poor prognosis were Sequential Organ Failure Assessment score (odds ratio 1.908; 95% confidence interval (CI) 1.235–3.681; P =0.0020) and PMI (odds ratio 13.478; 95%CI 1.342–332.690; P =0.0252). The cut-off PMI was 4.75 cm 2 /m 2 for males and 2.89 cm 2 /m 2 for females. Among survivors, duration of hospitalization was significantly longer in the low PMI group (29 days) than in the high PMI group (22 days, p=0.0257). Conclusions PMI is easily determined from CT and allows rapid evaluation of prognosis following lower gastrointestinal perforation.

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“…This is considered to lead to multiple organ failure and acute circulatory failure. In abdominal emergencies requiring surgery, the frequency of lower gastrointestinal perforation is not particularly high [13, 14]. Identification of prognostic factors to improve survival rates for this pathology has long been a priority, due to the high mortality rate [15–17].…”

Section: Discussionmentioning

confidence: 99%

Low psoas muscle index is a poor prognostic factor for lower gastrointestinal perforation: a single-center retrospective cohort study

et al. 2019

View full text Add to dashboard Cite

BackgroundVarious body composition indices have been reported as prognostic factors for different cancers. However, whether body composition affects prognosis after lower gastrointestinal tract perforation requiring emergency surgery and multidisciplinary treatment has not been clarified. This study examined whether body composition evaluations that can be measured easily and quickly from computed tomography (CT) are useful for predicting prognosis.MethodsSubjects comprised 64 patients diagnosed with perforation at final diagnosis after emergency surgery for a preoperative diagnosis of lower gastrointestinal tract perforation and penetration. They were divided into a survival group and a non-survival (in-hospital mortality) group and compared. Body composition indices (psoas muscle index (PMI); psoas muscle attenuation (PMA); subcutaneous adipose tissue index (SATI); visceral adipose tissue index (VATI); visceral-to-subcutaneous fat area ratio (VSR)) were measured from preoperative CT. Cross-sectional psoas muscle area at the level of the 3rd lumbar vertebra was quantified. Optimal cut-off values were calculated using receiver operating characteristic curve analysis. Poor prognostic factors were investigated from multivariate logistic regression analyses that included patient factors, perioperative factors, intraoperative factors, and body composition indices as explanatory variables.ResultsThe cause of perforation was malignant disease in 12 cases (18.7%), and benign disease in 52 cases (81.2%). The most common cause was diverticulum of the large intestine. Emergency surgery for the 64 patients led to survival in 52 patients and death in 12 patients. On multivariate logistic regression analysis, independent predictors of poor prognosis were Sequential Organ Failure Assessment score (odds ratio 1.908; 95% confidence interval (CI) 1.235–3.681; P = 0.0020) and PMI (odds ratio 13.478; 95%CI 1.342–332.690; P = 0.0252). The cut-off PMI was 4.75 cm2/m2 for males and 2.89 cm2/m2 for females. Among survivors, duration of hospitalization was significantly longer in the low PMI group (29 days) than in the high PMI group (22 days, p = 0.0257).ConclusionsPMI is easily determined from CT and allows rapid evaluation of prognosis following lower gastrointestinal perforation.

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Mortality after emergency abdominal surgery in a non‐metropolitan Australian centre

Cited by 12 publications

References 20 publications

Rural Emergency Laparotomy Audit

Rural Emergency Laparotomy Audit

Low psoas muscle index is a poor prognostic factor for lower gastrointestinal perforation: a single-center retrospective cohort study

Low psoas muscle index is a poor prognostic factor for lower gastrointestinal perforation: a single-center retrospective cohort study

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