Assessing differences in surgical outcomes following emergency abdominal exploration for complications of elective surgery and high-risk primary emergencies

Abstract

Irrespective of its etiology, emergency surgical abdominal exploration (EAE) is considered a high-risk procedure with mortality rates exceeding 20%. The aim of this study was to evaluate differences in outcomes in patients who required EAE due to complications of complex elective abdominal procedures and those who required EAE due to high-risk primary abdominal emergencies. Patients undergoing EAE for acute surgical complications of complex abdominal elective surgical procedures (N = 293; Elective group) and patients undergoing EAE for high-risk primary abdominal emergencies (N = 776; Emergency group) from 2012 to 2019 at our institution were retrospectively assessed for morbidity and mortality. Postoperative complications occurred in 196 patients (66.94%) in the elective group and 585 patients (75.4%) in the emergency group. The relatively low complication burden in the elective group was also evidenced by a significantly lower comprehensive complication index score (54.00 ± 37.36 vs. 59.25 ± 37.08, p = 0.040). The in-hospital mortality rates were 31% (91 of 293) and 38% (295 of 776) in the elective and emergency groups, respectively. This difference between the two groups was statistically significant (p = 0.035). In multivariate analysis, age, peripheral artery disease, pneumonia, thromboembolic events, ICU stay, ventilator dependence, acute kidney failure and liver failure were independent predictors of mortality. Our data show that patients undergoing EAE due to acute complications of major elective surgery tolerate the procedure relatively well compared with patients undergoing EAE due to primary high-risk abdominal emergencies.

Prognostic factors of poor postoperative outcomes in gastrectomies

“…We were able to demonstrate that only emergency surgery was significantly associated with poorer OS (HR 2.68, 95% CI 1.32-5.05, p = 0.003). This is in line with previously published studies which show that emergency abdominal surgery generally shows higher postoperative mortality rates (25,26). Additionally, a study focusing on emergency gastric surgery found in-hospital mortality rates of up to 50% (27).…”

Prophylactic Intra-abdominal Drains in Major Elective Surgeries: A Comprehensive Review

“…This preoperative assessment was associated with potentially reducing the risk of postoperative complications. However, the study also underscored the relatively low complication burden in the elective group, juxtaposed with markedly high mortality rates, reflecting the intrinsically high-risk nature of abdominal events [ 8 ].…”

Expertiza unor contestestații adresate Colegiului Medicilor din România vizând reclamații de erori chirurgicale

“…De remarcat că mortalitatea celor operanți în urgență a fost sensibil mai mare,11/17 (64,70%),constatare care era previzibilă, prezentă și în alte publicații (33,34). Operații laparoscopice au fost 9 (29,45%) cu 4 decese.…”

“…S-au adăugat și erorile latente, de sistem. După clasificarea Leape, majoritatea erorilor au fost de 33 Nicolau AE Erori chirurgicale-expertiza contestatiilor 34 diagnostic, 3 și de PTE 3,doar o eroare de tehnică operatorie, iar în toate cazurile s-au sumat și erori de sistem. Un articol de referință, care se bazează pe definiția complicației post operării utilizată în Olanda, analizează evoluția a 12.121 de pacienți internați în secția de chirurgie.…”