Dear Editor, Emergency laparotomy (EL) is a common procedure in the treatment of a myriad of potentially life-threatening abdominal conditions. Unlike elective surgery, EL is associated with high morbidity and mortality. 1-3 Compared to their younger counterparts, elderly patients are at higher risk of postoperative complications and mortality that are attributed to multiple comorbidities and reduced physiological reserves. 3-5 Additionally, patients who require EL tend to be critically ill with limited time for preoperative optimisation. Studies on EL have revealed substantial variations in processes and lack of coordination of EL care. 6-8 In the United Kingdom (UK), the National Emergency Laparotomy Audit (NELA) has shown a reduction in 30-day mortality from 11.8% to 9.5% since 2013. 6 In its third report, NELA described 9 key standards that can improve efficiency in the management of EL patients. To date, there is no standard practice in EL management in our institution and postoperative EL outcomes in Singapore are not known. In this study, we described EL outcomes in an acute hospital in Singapore, determined factors associated with 30-day mortality and explored perioperative outcomes in elderly patients.
Background
Early laparoscopic cholecystectomy (ELC) within 72 h of symptom onset is preferred for management of acute cholecystitis (AC). Beyond 72 h, acute‐on‐chronic fibrosis sets in rendering surgery challenging. This study aims to compare the outcomes of ELC for AC within and beyond 72 h of symptom onset by a dedicated acute surgical unit.
Methods
This is a single‐centre retrospective study of 217 patients with AC who underwent ELC by an acute surgical unit from January 2017 to August 2018. Outcomes collected include post‐operative morbidity, length of hospitalization and operation duration. A subgroup analysis for the same outcomes was performed for elderly patients.
Results
Of the 217 patients, 88 were operated within 72 h of symptom onset while 129 were operated beyond 72 h. Twenty‐six patients received ELC after 7 days. There was no occurrence of bile duct injury. There was no statistical difference in conversion rates, wound infections and post‐operative collections. Patients receiving ELC beyond 72 h had longer duration of operation (125.4 versus 116 min, P = 0.035) and length of hospitalization (4.59 versus 3.09 days, P = 0.001) without increase in morbidity. Patients older than 75 years had a higher incidence of post‐operative collection (P < 0.001).
Conclusion
Patients with AC undergoing ELC by a dedicated acute surgical unit can have good outcomes even beyond 72 h of symptom onset. Meticulous haemostasis should be performed for the elderly subgroup of patients.
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