Mortality rates of patients undergoing emergency laparotomy in an Irish university teaching hospital

Kiernan, Aoife C.; Waters, Peadar S; Tierney, Sean; Neary, Paul; Donnelly, Maria; Kavanagh, Dara; Egan, Bridget

doi:10.1007/s11845-018-1759-4

Cited by 8 publications

(6 citation statements)

References 13 publications

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“…The mortality rate of patients after emergency laparotomy in our study was 8.38%, which was relatively comparable with other studies done in Ethiopia, Gondar University (8.1%), UK (9.6%), and Ireland (6.66%) 9 , 21 , 22 . However, mortality is lower than in the study done by Awad et al .…”

Section: Discussionsupporting

confidence: 89%

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

Hailu

Ayinie

Amsalu

et al. 2023

Annals of Medicine &Amp; Surgery

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Background: Globally, emergency laparotomy is a frequently performed type of surgery with high morbidity and mortality rates, even in the best healthcare systems. There is limited knowledge regarding the outcome of emergency laparotomy performed in Ethiopia. Objective: To assess perioperative mortality and its predictors among patients undergoing emergency laparotomy at selected southern Ethiopian governmental hospitals. Methods: A multicenter prospective cohort study was conducted, and data were collected at selected hospitals after obtaining ethical approval from the Institutional Review Board. Data were analyzed using SPSS version 26. Results: The rate of postoperative complications after emergency laparotomy surgery was 39.3%, with an in-hospital mortality rate of 8.4% and a length of hospital stay of 9±6.5 days. The predictors of postoperative mortality were the age of the patient greater than 65 [adjusted odds ratio (AOR)=8.46, 95% CI=1.3–57.1], presence of intraoperative complications (AOR=7.26, 95% CI=1.3–41.3), and postoperative ICU admission (AOR=8.5, 95% CI=1.5–49.6). Conclusion: Our study revealed a significant level of postoperative complications and in-hospital mortality. The identified predictors should be sorted and applied to the preoperative optimization, risk assessment, and standardization of effective postoperative care following emergency laparotomy.

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Section: Discussionsupporting

confidence: 89%

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

Hailu

Ayinie

Amsalu

et al. 2023

Annals of Medicine &Amp; Surgery

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“…Interestingly, the indication for surgery, procedure performed and ultimate surgical pathology did not show a correlation with CCI. This is in contrast to what has been published previously with a number of studies showing markedly worse outcomes for patients undergoing emergency laparotomy for mesenteric ischaemia in particular 4, 5,11,20 .…”

Section: Discussioncontrasting

confidence: 99%

“…Previously published studies looking at perioperative factors have focused primarily on mortality as an outcome 5 , 15 , 16 . However, it has been well established that emergency surgery has a high risk of postoperative complications other than death, ranging from relatively minor complications such as ileus to severe complications, such as wound infection or stroke 17 , 18 .…”

Section: Discussionmentioning

confidence: 99%

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Perioperative factors associated with postoperative morbidity after emergency laparotomy: a retrospective analysis in a university teaching hospital

Ahmed

Garry

Moynihan

et al. 2020

Sci Rep

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Emergency Laparotomy (EL) is associated with significant morbidity and mortality. Variation in practice and patient outcomes for patients undergoing emergency laparotomy has been identified through the UK National Emergency Laparotomy Audit (NELA), with 30-day mortality ranging from 11 to 15%. A correlation between preoperative haemodynamic parameters and increased postoperative mortality has been demonstrated by both NELA and other observational studies. The association between intraoperative haemodynamic parameters and overall postoperative morbidity has not been evaluated in EL patients. The aims of our study were to investigate the association between perioperative haemodynamic and logistic parameters and postoperative morbidity in a tertiary referral university hospital; and to compare our outcomes to that of the NELA data. A retrospective analysis correlating a range of perioperative parameters with Comprehensive Complication Index (CCI) among 86 patients who underwent EL during 2018 was conducted. Mean age was 64 years (SD 16). Median CCI was 27 [9–45], and 30-day mortality was 11.7%. Several intraoperative parameters correlated with CCI on univariate analysis. On multivariate analysis, ASA status (P = 0.005) and unplanned escalation to postoperative intensive care (P = 0.03) were independently associated with CCI. Our study shows a correlation between ASA status and unplanned escalation to ITU with increased postoperative morbidity in patients undergoing emergency laparotomy. We did not demonstrate an independent correlation between intraoperative parameters and postoperative morbidity. These findings warrant confirmation in a larger scale observational study. Outcomes in our institution are comparable to those seen in the NELA.

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“…Multiple studies assessing perioperative factors in emergency laparotomies have primarily focused on mortality as an outcome [ 17 - 19 ]. It is well established that post-operative complications are common after emergency surgeries, which can range from minor to severe complications [ 20 , 21 ].…”

Section: Discussionmentioning

confidence: 99%

The Effect of Weekend Surgery on Outcomes of Emergency Laparotomy: Experience at a High Volume District General Hospital

Patel¹,

Thomas²,

Aguayo³

et al. 2022

Cureus

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Aims Emergency laparotomies (ELs) are associated with significant morbidity and mortality. Delays to the theater are inevitably associated with worse outcomes. Higher mortality has been reported with admissions over the weekend. The aim of this study is to compare the delays and outcomes of emergency laparotomies performed on weekdays (WD) and weekends (WE) at a high-volume, large district general hospital. Methods A retrospective review of a prospectively maintained database was performed for all patients who underwent general surgical emergency laparotomy between June and October 2021. Patient outcomes were compared between delayed and non-delayed surgeries as per the NCEPOD (National Confidential Enquiry into Patient Outcomes and Death) classification. The primary outcome compared was the 30-day post-operative mortality and morbidity determined by the Clavein-Dindo class ≥2. Secondary outcomes included the time from booking to anaesthesia start time, i.e., time to theatre (TTT), delay in surgery, out-of-hours (OOH) surgery, and unplanned return to theatres. Results Of the 103 laparotomies included, 33% were performed over the weekend. The most common indication for emergency laparotomy was bowel obstruction (53.4 %), followed by perforation (28.2%). There was no significant difference in mortality, the TTT (p = 0.218), delay in surgery with respect to the NCEPOD category of intervention (p = 0.401), postoperative length of stay (p = 0.555), number of cases operated OOH as well as unplanned return to theatres. There was a significant difference in the morbidity of patients between the two groups (Clavein-Dindo class ≥2, p = 0.021). Conclusion With consistent consultant involvement, an equivalent standard of weekend emergency surgical service can be delivered.

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Mortality rates of patients undergoing emergency laparotomy in an Irish university teaching hospital

Abstract: EL is associated with high mortality rates. Our mortality figures compare favourably with the NELA data. We support the development of a national database to facilitate improvements in the quality of care delivered to this high-risk cohort.

Cited by 8 publications

References 13 publications

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

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

Perioperative factors associated with postoperative morbidity after emergency laparotomy: a retrospective analysis in a university teaching hospital

The Effect of Weekend Surgery on Outcomes of Emergency Laparotomy: Experience at a High Volume District General Hospital

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