Mortality following emergency laparotomy: a Swedish cohort study

Abstract

Background Emergency laparotomy (EL) is a central, high-risk procedure in emergency surgery. Patients in need of an EL present an acute pathology in the abdomen that must be operated on in order to save their lives. Usually, the underlying condition produces an affected physiology. The perioperative management of this critically ill patient group in need of high-risk surgery and anaesthesia is challenging and related to high mortality worldwide. However, outcomes in Sweden have yet to be studied. This retrospective cohort study explores the perioperative management and outcome after 710 ELs by investigating mortality, overall length of stay (LOS) in hospital, need for care at the intensive care unit (ICU), surgical complications and a general review of perioperative management. Methods Medical records after laparotomy was retrospectively analysed for a period of 38 months (2014–2017), the emergency cases were included. Children (< 18 years), aortic surgery, second look and other expected reoperations were excluded. Demographic, management and outcome data were collected after an extensive analysis of the cohort. Results A total of 710 consecutive operations, representing 663 patients, were included in the cohort (mean age 65.6 years). Mortality (30 days/1 year) after all operations was 14.2% and 26.6% respectively. The mean LOS in hospital was 12 days, while LOS in the ICU was five days. Of all operations, 23.8% patients were admitted at any time to the ICU postoperatively and the 30-day mortality seen among ICU patients was 37.9%. Mortality was strongly correlated to existing comorbidity, high ASA classification, ICU care and faecal peritonitis. The mean/median time from notification to operate until the first incision was 3:46/3:02 h and 87% of patients had their first incision within 6 h of notification. Conclusions In this present Swedish study, high mortality and morbidity were observed after emergency laparotomy, which is in agreement with other recent studies. Trial registration: The study has been registered with ClinicalTrials.gov (NCT03549624, registered 8 June 2018).

Perioperative mortality and its predictors among patients undergoing emergency laparotomy at selected southern Ethiopian governmental hospitals, 2022: a multicenter prospective cohort study

“…Previous studies have shown that emergency laparotomy was associated with high mortality and complication rate compared to those elective surgeries 6 , 7 . The reported global incidence rates of mortality and complication during emergency laparotomy range from 13 to 18% at 30 days, increasing to 25% at 24 months and 50% of complication rates, which is five-fold higher than that of elective surgery 6 , 8 . According to a study conducted in Ethiopia, the mortality rate of the patient is 8.1, and the complication rate is 13.5% after an emergency laparotomy 9 .…”

Combining sarcopenia and ASA status to inform emergency laparotomy outcomes: could it be that simple?

“…Despite the ASA score's inter-observer consistency being constantly challenged, [25][26][27] it continues to be widely used, and has been proven to be a reliable predictor for surgical mortality. [28][29][30][31][32][33][34][35][36] ASA physical status is commonly used in Australia as a preoperative assessment of patients by anaesthetists. It is incorporated as part of the WHO safety checklist in most operating theatres, making ASA the only formal risk assessment tool required for a patient to undergo surgery.…”

“…Both NELA and ACS‐NSQIP have incorporated the American Society of Anaesthesiologists (ASA) score into their algorithms. Despite the ASA score's inter‐observer consistency being constantly challenged, 25–27 it continues to be widely used, and has been proven to be a reliable predictor for surgical mortality 28–36 . ASA physical status is commonly used in Australia as a preoperative assessment of patients by anaesthetists.…”

Prospective multicenter external validation of postoperative mortality prediction tools in patients undergoing emergency laparotomy

“…Despite documented advances in the modern era, 1 mortality following EL remains substantial worldwide, affecting up to one of every five patients in the first 30 postoperative days in high-quality health care systems. [2][3][4][5] Efforts to standardize perioperative care of EL patients through implementation of predetermined pathways have led to reduction in postoperative mortality. 6 Standardization in contemporary practice requires calculation and consideration of the risks associated with EL before entering the operating room.…”

“…Emergency laparotomy (EL) is a common procedure performed worldwide for a wide variety of abdominal pathologies. Despite documented advances in the modern era, 1 mortality following EL remains substantial worldwide, affecting up to one of every five patients in the first 30 postoperative days in high-quality health care systems 2–5 . Efforts to standardize perioperative care of EL patients through implementation of predetermined pathways have led to reduction in postoperative mortality 6 .…”