Why aren't patients having emergency laparotomy when presenting with acute surgical pathology - a single site experience

Abstract

Abstract Aim To establish the documented cause for not proceeding to emergency laparotomy for the acute general surgical patient Methods Retrospective single site review of all emergency patients admitted over three calendar months. Identification of and further collection of data for patients that did not proceed to Emergency Laparotomy despite indicative pathology. Results A total of 619 emergency general surgical patients were admitted from 1st January to 31st March 2023. 39 (6.3%) patients had an Emergency Laparotomy. 17 (2.7%) patients did not proceed to laparotomy despite pathology that could indicate the need for emergency laparotomy. 100% of these patients has CT imaging to diagnose the pathology. Of the 17 patients without laparotomy median age of 86 years (range 42 – 91 years) and 12 were female. Two patients made the decision that they did not want to proceed with emergency laparotomy, both male (75 and 88 years old) and both were reviewed by Care of the Elderly. Relatives were also involved with decision making. Both died in hospital. Two were managed conservatively, the decision was made by the Consultant Surgeon, both patients were female (42 and 55 years old) and both survived to discharge and at 30 days. All remaining 13 patients had documentation of frailty as being the cause for not proceeding. Although all >65 years, 4 did not see a Care of Elderly. 4 patients survived to 30 days. Conclusion Principles of futility in medical care are published in literature and surgeons should use these in documentation for clarification.