Staged laparotomy for acute non-traumatic intra-abdominal emergencies in a tertiary South African unit.

Abstract

Patients undergoing laparotomy for emergency general surgery (EGS) have poor outcomes. Attempts have been made to improve these outcomes by adopting damage control principles known to benefit polytraumatized patients. Studies describing the use of staged laparotomy (SL) in EGS have been modest in size and heterogenous. The aim of this study was to describe our experience with SL at a tertiary hospital in KwaZulu-Natal, South Africa. The Hybrid Electronic Medical Registry (HEMR) at Greys Hospital was interrogated for all consecutive admissions undergoing staged EGS laparotomy. Descriptive and inferential statistics were performed. From 2012 to 2018, 242 patients (16.5% of all EGS laparotomies) underwent SL for an EGS condition. The median patient age was 38 years old (IQR 27-56 years). Physiological indications were present in 125 patients (51.7%) and non-physiological indications (NPI) in 117 (48.3%). Haemodynamic instability was the most common physiological indication (51; 21.1%) and gross contamination was the most non-physiological indication (91; 37.6%). Adverse event and mortality rates were 84.8% and 26.9%, respectively. Independent predictors of mortality were enteric breach (OR3.9; 95% CI (2.1-7.8)), physiological indication (OR 2.1; 95% CI (1.1-3.7)) and anastomosis (OR 2.0; 1.05-3.73). "Clip and drop" did not contribute to mortality (P= 0.43; OR1.34 (0.64-2.7)). Mortality was higher in the group without repeat laparotomy. Mortality rate was not associated with increasing number of relaparotomies. Patients undergoing EGS laparotomy form a high-risk group. "Clip and drop" approach and number of relaparotomies were not associated with mortality. Indications and components of this approach need to be standardized.