Mortality and postoperative care pathways after emergency gastrointestinal surgery in 2904 patients: a population-based cohort study

Vester‐Andersen, Morten; Lundstrøm, Lars Hyldborg; Møller, Morten Hylander; Waldau, T.; Rosenberg, Jacob; Møller, Ann Merete

doi:10.1093/bja/aet487

Cited by 157 publications

(155 citation statements)

References 30 publications

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“…Cela est un reflet de notre démographie où la pyramide des âges est à base élargie. En Occident, au contraire, où la population est vieillissante, on retrouve des moyennes d'âge plus élevées [25,27]. Le retard à la consultation lié à des facteurs socio-économiques et culturels a été rapporté par d'autres auteurs [17,26].…”

Section: Discussionunclassified

“…L'appendicectomie et les iléostomies sont les gestes chirurgicaux couramment réalisés en Afrique et le plus souvent par laparotomie [3,6,26]. Vester-Andersen et al [27], au Danemark, en 2014, ont rapporté 53,2 % d'interventions sur la sphère intestinale réalisée à 93,2 % par laparotomie et seulement 6,8 % de laparoscopies, mais son étude avait exclu de prime abord toutes les appendicectomies. La laparotomie reste encore la voie d'abord essentielle en matière d'abdomen aigu chirurgical.…”

Section: Discussionunclassified

“…Les séries de Vester-Andersen et al [27] au Danemark et de Saunders et al [25] au Royaume-Uni, comportant une forte population de sujets âgés avec de nombreuses tares, ont néanmoins retrouvé des létalités respectives de 18,5 et 14,9 %. Ahmed et al [3] à Zaria ont rapporté un faible taux de 4,5 %, principalement dû aux pathologies tumorales opérées en urgence par laparotomie.…”

Section: Discussionunclassified

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Urgences chirurgicales digestives en Afrique subsaharienne : étude prospective d’une série de 622 patients à l’Hôpital national de Zinder, Niger

Magagi

Adamou

Habou

et al. 2016

Bull. Soc. Pathol. Exot.

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The purpose of this study was to describe the epidemiologic, therapeutic, and prognostic aspects of surgical acute abdomen at the National Hospital of Zinder (HNZ). This was a prospective study of patients undergoing digestive surgical emergencies in HNZ over 24 months (January 2013-December 2014). During the study period, 622 digestive surgical emergencies were operated. The mean age was 22.91 ± 18.14 years old, with a sex-ratio of 3:1. The average admission time was 64.31 ± 57.90 h. Abdominal pain was the main reason for admission in 61.90% (N = 385) of the cases, with or without fever throughout the course in 26.05% (N = 162) of the cases. The average time before surgery was 9.13 ± 5.97 h. Acute peritonitis accounted for 51.61% (N = 321) of cases, led by ileal perforation maybe from typhoid (N = 175). The acute intestinal obstruction and acute appendicitis accounted for 27.49% (N = 171) and 9.65% (N = 60) of the cases, respectively. Abdominal trauma had affected 53 patients (8.52%). The average length of hospital stay was 8.71 ± 5.29 days. Postoperative morbidity was 38.10% (N = 237). Septic complications (N = 187) were predominant. Overall lethality of 13.67% (N = 85), was associated with the delay of diagnosis and treatment (P < 0.001). The incidence and the high morbidity and lethality of digestive surgical emergencies in the Sub-Saharan context, could be avoided through prevention, early consultation, and adequate intra-hospital management.

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Urgences chirurgicales digestives en Afrique subsaharienne : étude prospective d’une série de 622 patients à l’Hôpital national de Zinder, Niger

Magagi

Adamou

Habou

et al. 2016

Bull. Soc. Pathol. Exot.

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“…[1][2][3][4][5][6] It is defined as immediate emergency laparoscopy or laparotomy primarily to treat intestinal obstruction, perforated viscus or bowel ischemia. 7 A focus on enhanced recovery programs specifically for patients following AHA surgery is needed to improve the postoperative outcome.…”

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confidence: 99%

Physical performance following acute high-risk abdominal surgery: a prospective cohort study

Jønsson

Ingelsrud

Tengberg

et al. 2018

cjs

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Background: Acute high-risk abdominal (AHA) surgery is associated with high mortality, multiple postoperative complications and prolonged hospital stay. Further development of strategies for enhanced recovery programs following AHA surgery is needed. The aim of this study was to describe physical performance and barriers to independent mobilization among patients who received AHA surgery (postoperative days [POD] 1-7). Methods:Patients undergoing AHA surgery were consecutively enrolled from a university hospital in Denmark. In the first postoperative week, all patients were evaluated daily with regards to physical performance, using the Cumulated Ambulation Score (CAS; 0-6 points) to assess basic mobility and the activPAL monitor to assess the 24-hour physical activity level. We recorded barriers to independent mobilization.Results: Fifty patients undergoing AHA surgery (mean age 61.4 ± 17.2 years) were included. Seven patients died within the first postoperative week, and 15 of 43 (35%) patients were still not independently mobilized (CAS < 6) on POD-7, which was associated with pulmonary complications developing (53% v. 14% in those with CAS = 6, p = 0.012). The patients lay or sat for a median of 23.4 hours daily during the first week after AHA surgery, and the main barriers to independent mobilization were fatigue and abdominal pain. Conclusion:Patients who receive AHA surgery have very limited physical performance in the first postoperative week. Barriers to independent mobilization are primarily fatigue and abdominal pain. Further studies investigating strategies for early mobilization and barriers to mobilization in the immediate postoperative period after AHA surgery are needed.Contexte : La chirurgie abdominale d'urgence à risque élevé est associée à un fort taux de mortalité, à des complications postopératoires multiples et à des hospitalisations prolongées. Il est donc nécessaire d'élaborer de nouvelles stratégies pour amélio-rer le rétablissement après ce type de chirurgie. La présente étude visait à décrire le fonctionnement physique et les obstacles aux déplacements autonomes chez les patients ayant subi une chirurgie de ce type (jours postopératoires 1 à 7).Méthodes : Nous avons recruté successivement les patients subissant une chirurgie abdominale d'urgence à risque élevé dans un hôpital universitaire du Danemark. Durant la première semaine postopératoire, tous les patients ont subi quotidiennement une évaluation visant à vérifier leur fonctionnement physique. Nous nous sommes servis du Cumulated Ambulation Score (CAS; de 0 à 6 points) pour évaluer la mobilité de base et du moniteur activPAL pour évaluer le niveau d'activé physique 24 heures par jour. Nous avons noté les obstacles aux déplacements autonomes.Résultats : Cinquante patients (âge moyen : 61,4 ans ± 17,2) ont été retenus. Sept sont décédés durant la première semaine postopératoire, et 15 des 43 patients restants (35 %) ne se déplaçaient pas encore de façon autonome (CAS < 6) le septième jour, une situation associée à l'apparition de c...

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“…4 Other countries also show high average mortality, with a Danish cohort study showing a mean mortality of 18.5% at 30 days. 5 Long-term outcomes are even worse, with only 49% of patients more than 80 years of age who had undergone nonelective colorectal resection alive at 1 year. 6 The resource burden of emergency general surgery is high, with a 10-year analysis of the US Nationwide Inpatient sample (2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010) showing that 7.1% of all hospital admissions were related to EGS, with 29% of these patients requiring surgery; the population-adjusted case rate of 1290 admissions per 100,000 people was higher than the sum of all new cancer diagnoses, and has increased annually since 2001.…”

Section: Epidemiologymentioning

confidence: 99%

Anesthesia for Emergency Abdominal Surgery

Peden

Scott

2015

Anesthesiology Clinics

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Mortality and postoperative care pathways after emergency gastrointestinal surgery in 2904 patients: a population-based cohort study

Cited by 157 publications

References 30 publications

Urgences chirurgicales digestives en Afrique subsaharienne : étude prospective d’une série de 622 patients à l’Hôpital national de Zinder, Niger

Urgences chirurgicales digestives en Afrique subsaharienne : étude prospective d’une série de 622 patients à l’Hôpital national de Zinder, Niger

Physical performance following acute high-risk abdominal surgery: a prospective cohort study

Anesthesia for Emergency Abdominal Surgery

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