Abstract
BackgroundEmergency 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.MethodsMedical 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.ResultsA 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.ConclusionsIn 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).
Highlights
Emergency laparotomy (EL) is a central, high-risk procedure in emergency surgery
We aim to explore the outcome after EL in 710 consecutive patients with respect to primary (30-day mortality) and secondary endpoints
The current study investigates the outcome and perioperative management in a cohort of adult patients undergoing EL
Summary
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. A typical case may generally be an elderly patient with comorbidities and a pathological abdominal condition affecting organ function and generating critical illness, where the necessary action is an EL. It is a challenge for healthcare providers to handle these complex cases to ensure the best possible outcome [12]. Great efforts have been made to improve the postoperative outcome for patients undergoing an EL [11, 13, 14] These studies indicate that the postoperative patient outcome can be improved by standardised perioperative management, a care bundle, with several key actions and measures, together with a high level of competence in the responsible surgeon and anaesthesiologist
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