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

Abstract

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.

Continuous Spinal Anaesthesia (CSA) for Emergency Laparotomy in High-Risk Elderly patients: Technique and Outcomes of a Prospective Service Evaluation

“…In conclusion, emergency laparotomy carries well-recognised intra and postoperative risks and in the elderly cohort, these risks are significant and probably life threatening [8,9]. General anaesthesia could play role in compounding these risks in the elderly patient.…”

“…The mean P POSSUM (Portsmouth Physiological and Operative Severity Score for enUmeration of Mortality and Morbidity) mortality score of our cohort was 20.5 % [7] . 30-day mortality in the elderly adult undergoing emergency laparotomy is between 14.6 -33.3 % [8,9] . The 30-day mortality in our small cohort was 14 % (3/21).…”

Prioritising emergency laparotomy – a reply

“…Unintentional administration of neuromuscular blocking agents to a non-anaesthetised patient can result in severe consequences and emotional distress for the patient and the anaesthetist. The NAP5 report included 17 cases of 'drug errors and awake paralysis'; 11 of these were due to syringe swaps [1]. This is supported by analysis from the Australian Incident Monitoring System which reports that 36% of 2000 anaesthesia-related incidents were drug errors, of which 58 were syringe swaps; 71% involved neuromuscular blocking agents [4].…”

“…In response to the 5th National Audit Project (NAP5) report [1], Rowe advocates the introduction of red-plunger syringes for neuromuscular blocking drugs [2], a practice that is already widespread in Australia and New Zealand [3]. Unintentional administration of neuromuscular blocking agents to a non-anaesthetised patient can result in severe consequences and emotional distress for the patient and the anaesthetist.…”

Prioritising emergency laparotomy

“…I would like to thank Dr. Shah for these comments about our paper [1]. We did not perform a full neurological examination on our patients before placing an epidural blood patch.…”