One‐ and Two‐Year Outcomes and Predictors of Mortality Following Emergency Laparotomy: A Consecutive Series from a United Kingdom Teaching Hospital

Awad, Sherif; Herrod, Philip; Palmer, Rachel; Carty, Hyunmi; Abercrombie, J F; Brooks, Adam; Beer, Thearina de; Mole, Jonathan; Lobo, Dileep N.

doi:10.1007/s00268-012-1614-0

Cited by 39 publications

(66 citation statements)

References 20 publications

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“…Major infective complications during the early postoperative period were seen in 72% of patients undergoing emergency laparotomy at a UK teaching hospital [23]. This is similar to the 76% we observed by day 28.…”

Section: Discussionsupporting

confidence: 78%

Postoperative morbidity survey, mortality and length of stay following emergency laparotomy

et al. 2015

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SummaryThirty-day mortality following emergency laparotomy is high, and greater amongst elderly patients. Studies systematically describing peri-operative complications are sparse, and heterogeneous. We used the postoperative morbidity survey to describe the type and frequency of complications, and their relationship with outcomes for 144 patients: 114 < 80 years old, and 30 ≥ 80 years old. Cumulative postoperative morbidity survey scores and patterns of morbidity were similar (p = 0.454); however, 28-day mortality was higher in the elderly (10/30 (33.3%) vs 11/114 (9.6%), p = 0.008), and hospital stay was longer (median (IQR [range]) 17 (13-35 [6-62]) days vs 11 (7-21 [2-159]) days, p = 0.006). Regression analysis indicated that cardiovascular, haematological, renal and wound complications were associated with longer hospital stay, and that cardiovascular complications predicted mortality. The postoperative morbidity survey system enabled structured mapping of the number and type of complications, and their relationship with outcome, following emergency laparotomy. These results indicate that rather than a greater propensity to complications following surgery, it was the failure to tolerate these that increased mortality in the elderly.

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Section: Discussionsupporting

confidence: 78%

Postoperative morbidity survey, mortality and length of stay following emergency laparotomy

et al. 2015

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“…5,17 The ELN data on the procedural distribution of emergency laparotomies should inform emergency surgery workforce planning. Colorectal procedures are most common, followed by procedures classified as general surgical, over half of which involve surgery to the small bowel.…”

Section: Discussionmentioning

confidence: 99%

“…5,6 However, the impact on mortality of the specific procedure has not been properly evaluated. Changes in service provision for emergency general surgery are currently topical, and should be underpinned by data concerning the risk associated with different pathologies and specific procedures.…”

mentioning

confidence: 99%

“…1,2 These procedures are associated with a high risk of mortality and morbidity, and until recently, there had only been a limited number of single centre studies reporting outcomes in the UK population. [2][3][4][5] This deficit was addressed by the first report of the UK Emergency Laparotomy Network (ELN), which detailed prospective outcome data for 1,853 patients undergoing emergency laparotomy. 6 That report confirmed that emergency laparotomy in the UK carries a high mortality, with an unadjusted 30-day mortality rate of 14.9% for all patients and 24.4% for those over the age of 80 years.…”

mentioning

confidence: 99%

“…Emergency laparotomy encompasses a diverse range of procedures, and there is general agreement that mortality is related to advancing age, [2][3][4][5][6]12 ASA (American Society of Anesthesiologists) grade, 3,6,12 increased urgency of surgery 6 and the need for postoperative critical care. 5,6 However, the impact on mortality of the specific procedure has not been properly evaluated.…”

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confidence: 99%

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Current UK practice in emergency laparotomy

Barrow¹,

Anderson²,

Varley³

et al. 2013

annals

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on behalf of the UK Emergency Laparotomy Network ABStRAct INTRODUCTION Emergency laparotomy is a common procedure, with 30,000-50,000 performed annually in the UK. This large scale study reports the current spectrum of emergency laparotomies, and the influence of the surgical procedure, underlying pathology and subspecialty of the operating surgeon on mortality. METHODS Anonymised data on consecutive patients undergoing an emergency laparotomy were submitted for a three-month period. The primary outcome measure was unadjusted 30-day mortality. Appendicectomy and cholecystectomy were among the procedures excluded. RESULTS Data from 1,708 patients from 35 National Health Service hospitals were analysed. The overall 30-day mortality rate was 14.8%. 'True' emergency laparotomies (ie those classified by the National Confidential Enquiry into Patient Outcome and Death as immediate or urgent) comprised 86.5% of cases. The mortality rate rose from 8.0% among expedited cases to 14.3% among urgent cases and to 25.7% among laparotomies termed immediate. Among the most common index procedures, small bowel resection exhibited the highest 30-day mortality rate of 21.1%. The presence of abdominal sepsis was associated with raised 30-day mortality (17.5% in the presence of sepsis vs 12.6%, p=0.027). Colorectal procedures comprised 44.3% and within this group, data suggest that mortality from laparotomy may be influenced by surgical subspecialisation. CONCLUSIONS This report of a large number of patients undergoing emergency laparotomy in the UK confirms a remarkably high mortality by modern standards across the range. Very few pathologies or procedures can be considered anything other than high risk. The need for routine consultant involvement and critical care is evident, and the case distribution helps define the surgical skill set needed for a modern emergency laparotomy service. Preliminary data relating outcomes from emergency colonic surgery to surgical subspecialty require urgent further study.

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Randomized multicentre feasibility trial of intermediate care versus standard ward care after emergency abdominal surgery (InCare trial)

Vester‐Andersen

Waldau

Wetterslev³

et al. 2015

British Journal of Surgery

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One‐ and Two‐Year Outcomes and Predictors of Mortality Following Emergency Laparotomy: A Consecutive Series from a United Kingdom Teaching Hospital

Abstract: Patients who underwent EML had favourable outcomes, with 2-year survival close to 75 %. Age ≥70 years and the need for postoperative ICU/HDU care were independent predictors of mortality.

Cited by 39 publications

References 20 publications

Postoperative morbidity survey, mortality and length of stay following emergency laparotomy

Postoperative morbidity survey, mortality and length of stay following emergency laparotomy

Current UK practice in emergency laparotomy

Randomized multicentre feasibility trial of intermediate care versus standard ward care after emergency abdominal surgery (InCare trial)

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