WE5.5 Does use of laparoscopy in emergency surgery improve mortality rates? A single centre experience

Abstract

Abstract Aims With the progression of minimally invasive surgery across surgical specialties in the elective setting, we aimed to assess the translation of laparoscopic surgery into emergency surgery in our district general hospital. The National Emergency Laparotomy Audit (NELA) provides us with an excellent database to review our single-centre's experience over time. Methods Using data collected as part of the NELA, we reviewed available operations between 2013 and 2021 at our centre, and compared outcomes between open, laparoscopic, laparoscopic-assisted (LA), and laparoscopic-converted-to-open (LCTO) operations. The primary outcome was mortality. Our secondary outcomes were variables that guided decision to operate laparoscopically versus laparotomy. Results 1236 operations were identified; 205 (17%) were either laparoscopic, LA, or LCTO. 60-day mortality in all laparoscopic groups was significantly lower at 4.4% compared with 10.0% in the open group (p-value 0.008). This finding was lost when variables of age, ASA grade, or pre-operative P-possum mortality were adjusted for. Conclusion Laparoscopic surgery was performed on a small, selected group. It is a safe and valuable choice for many patients, particularly with upper-GI pathology and may contribute to improved mortality. However, whilst at first glance laparoscopic approaches to the emergency surgical abdomen appear to improve mortality, this likely represents a well-known clinician-led process of selecting patients with greater fitness and lower predicted pre-operative mortality, therefore muddying the significance of this apparent benefit. This is comparable with national data.