Complications after emergency laparotomy beyond the immediate postoperative period - a retrospective, observational cohort study of 1139 patients

Abstract

Mortality and morbidity occur commonly following emergency laparotomy, and incur a considerable clinical and financial healthcare burden. Limited data have been published describing the postoperative course and temporal pattern of complications after emergency laparotomy. We undertook a retrospective, observational, multicentre study of complications in 1139 patients after emergency laparotomy. A major complication occurred in 537/1139 (47%) of all patients within 30 days of surgery. Unadjusted 30-day mortality was 20.2% and 1-year mortality was 34%. One hundred and thirty-seven of 230 (60%) deaths occurred between 72 h and 30 days after surgery; all of these patients had complications, indicating that there is a prolonged period with a high frequency of complications and mortality after emergency laparotomy. We conclude that peri-operative, enhanced recovery care bundles for preventing complications should extend their focus on continuous complication detection and rescue beyond the first few postoperative days.

The association between epidural analgesia and mortality in emergency abdominal surgery: A population‐based cohort study

“…In emergency abdominal surgery, one could theorize that post‐operative epidural analgesia could potentially reduce paralytic ileus and pain, thus increasing mobilization, deep breathing, and coughing. Collectively, these effects could potentially reduce pulmonary complications and thereby reduce mortality . In our study, the strongest association in favour of epidural analgesia was observed in major laparotomy patients, supporting this theory.…”

“…We found an epidural analgesia rate of 28%, which was twice as frequent as reported by an earlier study on emergency abdominal surgery patients . Furthermore, we observed substantial inter‐hospital practice variation in the use of epidural analgesia, with higher rates in hospitals with an intermediate surgical volume as compared to hospitals with high surgical volume.…”

“…Furthermore, epidural analgesia carries the risk of hypotension, which may be more pronounced among frail, elderly septic patients . Thus, some anesthesiologists may be reluctant to insert epidural catheters in frail emergency abdominal patients, who are at high risk of sepsis and sepsis shock . Internationally, variation in recommendation is also evident .…”

“…Emergency abdominal surgery carries a short‐term mortality risk of 10%‐20%, and post‐operative complications are common, especially respiratory complications, which can be serious and affect 19%‐21% of patients . In general, patients undergoing emergency abdominal surgery are frail, elderly with multiple comorbidities, and many are septic before surgery . In major elective surgery, epidural analgesia has been shown to reduce mortality, pneumonia, atelectasis and respiratory depression .…”

Time course and reasons for 90‐day mortality in fast‐track hip and knee arthroplasty

“…This may be of particular importance given the low 90‐days mortality where the inclusion of even a few of deaths without relation to surgery may effect data interpretation. However, whether this can be generalized to other procedures is uncertain, as mortality in emergency surgery, general surgery, and even in revision THA is higher and with different procedure‐related organ dysfunction, The present study has some other limitations, most importantly regarding quality and interpretation of the medical records. Although the use of independent reviews of all available information may limit potential bias, evaluation of medical records is bound to be subjective, and any lack of information may ultimately have affected our evaluation on relation to surgery.…”