Current UK practice in emergency laparotomy

Abstract

on behalf of the UK Emergency Laparotomy Network ABStRAct INTRODUCTION Emergency laparotomy is a common procedure, with 30,000-50,000 performed annually in the UK. This large scale study reports the current spectrum of emergency laparotomies, and the influence of the surgical procedure, underlying pathology and subspecialty of the operating surgeon on mortality. METHODS Anonymised data on consecutive patients undergoing an emergency laparotomy were submitted for a three-month period. The primary outcome measure was unadjusted 30-day mortality. Appendicectomy and cholecystectomy were among the procedures excluded. RESULTS Data from 1,708 patients from 35 National Health Service hospitals were analysed. The overall 30-day mortality rate was 14.8%. 'True' emergency laparotomies (ie those classified by the National Confidential Enquiry into Patient Outcome and Death as immediate or urgent) comprised 86.5% of cases. The mortality rate rose from 8.0% among expedited cases to 14.3% among urgent cases and to 25.7% among laparotomies termed immediate. Among the most common index procedures, small bowel resection exhibited the highest 30-day mortality rate of 21.1%. The presence of abdominal sepsis was associated with raised 30-day mortality (17.5% in the presence of sepsis vs 12.6%, p=0.027). Colorectal procedures comprised 44.3% and within this group, data suggest that mortality from laparotomy may be influenced by surgical subspecialisation. CONCLUSIONS This report of a large number of patients undergoing emergency laparotomy in the UK confirms a remarkably high mortality by modern standards across the range. Very few pathologies or procedures can be considered anything other than high risk. The need for routine consultant involvement and critical care is evident, and the case distribution helps define the surgical skill set needed for a modern emergency laparotomy service. Preliminary data relating outcomes from emergency colonic surgery to surgical subspecialty require urgent further study.

Mortality after emergency abdominal surgery in a non‐metropolitan Australian centre

“…A recent US study reported that emergency operations account for 15% of all general surgical procedures and for almost 54% of all postoperative deaths . In emergency general surgery, very few pathologies or procedures can be considered anything other than high‐risk . Compared to emergency surgery, the risk of death associated with major elective surgery is relatively low and has been reported to range between 1.5% and 10% .…”

Outcomes in emergency general surgery following the introduction of a consultant-led unit

“…For patients undergoing emergency laparotomy, the overall morbidity and mortality rates in the EGS cohort were 19·0 and 12 per cent respectively. The overall mortality rate in patients having emergency laparotomy has been reported to be approximately 14–15 per cent.…”

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

“…Emergency laparotomy is associated with high rates of mortality and postoperative complications, as well as prolonged hospital stay [1][2][3][4][5][6]. There is considerable heterogeneity in patient factors, underlying pathology and surgical procedures, but perforated viscus, intestinal obstruction, bowel ischaemia and haemorrhage are common [4]. Compared with other acute surgical emergencies, patients undergoing emergency laparotomy have a disproportionately high mortality [7] in younger, fitter patients [8] as well as older, sicker patients [9].…”