New Zealand and Australia emergency laparotomy mortality rates compare favourably to international outcomes: a systematic review

Fagan, Georgina; Barazanchi, Ahmed; Coulter, Grant; Leeman, Matthew F; Hill, Andrew; Eglinton, Tim

doi:10.1111/ans.16563

Cited by 16 publications

(16 citation statements)

References 38 publications

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“…Emergency laparotomy is a time-sensitive procedure with a high mortality range from 8.8 to 18.6% [ 1 – 3 ], which is much higher than elective surgeries [ 4 – 6 ]. Elderly patients suffering worse morbidity and mortality following emergency laparotomy have been contributed to multiple medical comorbidities and nutrition status [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Effect of sarcopenia in predicting postoperative mortality in emergency laparotomy: a systematic review and meta-analysis

Luo

Deng

et al. 2022

World J Emerg Surg

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Background While emergency laparotomy has been associated with high rates of postoperative mortality and adverse events, preoperative systematic evaluation of patients may improve perioperative outcomes. However, due to the critical condition of the patient and the limited operation time, it is challenging to conduct a comprehensive evaluation. In recent years, sarcopenia is considered a health problem associated with an increased incidence of poor prognosis. This study aimed to investigate the effect of sarcopenia on 30-day mortality and postoperative adverse events in patients undergoing emergency laparotomy. Methods We systematically searched databases including PubMed, Embase, and Cochrane for all studies comparing emergency laparotomy in patients with and without sarcopenia up to March 1, 2022. The primary outcome was of 30-day postoperative mortality. Secondary outcomes were the length of hospital stay, the incidence of adverse events, number of postoperative intensive care unit (ICU) admissions, and ICU length of stay. Study and outcome-specific risk of bias were assessed using the Quality in Prognosis Studies (QUIPS) tool. We rated the certainty of evidence using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE). Result A total of 11 eligible studies were included in this study. The results showed that patients with sarcopenia had a higher risk of death 30 days after surgery (OR = 2.42, 95% CI = 1.93–3.05, P < 0.00001). More patients were admitted to ICU after surgery (OR = 1.58, 95% CI = 1.11–2.25, P = 0.01). Both the ICU length of stay (MD = 0.55, 95% CI = 0.05–1.06, P = 0.03) and hospital length of stay (MD = 2.33, 95% CI = 1.33–3.32, P < 0.00001) were longer in the sarcopenia group. The incidence of postoperative complications was also significantly higher in patients with sarcopenia (OR = 1.78, 95% CI = 1.41–2.26, P < 0.00001). Conclusion In emergency laparotomy, sarcopenia was associated with increased 30-day postoperative mortality. Both the lengths of stay in the ICU and the total length of hospital stay were significantly higher than those in non-sarcopenic patients. Therefore, we concluded that sarcopenia can be used as a tool to identify preoperative high-risk patients, which can be considered to develop new postoperative risk prediction models. Registration number Registered on Prospero with the registration number of CRD42022300132.

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Section: Introductionmentioning

confidence: 99%

Effect of sarcopenia in predicting postoperative mortality in emergency laparotomy: a systematic review and meta-analysis

Luo

Deng

et al. 2022

World J Emerg Surg

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“…Det er få studier av aku e laparotomier i et skandinavisk pasientmateriale (10). Formålet med denne studien var å kartlegge pasientkarakteristika, sykehusforløp og mortalitet for pasienter som har gjennomgå aku e laparotomier ved St. Olavs hospital.…”

Section: H Ov Eunclassified

Emergency laparotomy at St Olav's Hospital, Trondheim

Wangen¹,

Gillund²,

Reinholdtsen³

et al. 2023

Tidsskriftet

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Aku e laparotomier ved St. Olavs hospital ORIGINALARTIKKEL NTNU Forfa erbidrag: idé, utforming/design, datainnsamling, analyse og tolkning av data samt utarbeiding og revisjon av manuset. Endre Wangen er cand.med. Forfa eren har fylt ut ICMJE-skjemaet og oppgir ingen interessekonflikter. NTNU Forfa erbidrag: idé, utforming/design, datainnsamling, analyse og tolkning av data samt utarbeiding og revisjon av manuset. Even Westgaard Gillund er cand.med. Forfa eren har fylt ut ICMJE-skjemaet og oppgir ingen interessekonflikter. NTNU Forfa erbidrag: idé, utforming/design, datainnsamling, analyse og tolkning av data samt utarbeiding og revisjon av manuset. Eirik Midtgaard Reinholdtsen er cand.med. Forfa eren har fylt ut ICMJE-skjemaet og oppgir ingen interessekonflikter. NTNU Forfa erbidrag: idé, utforming/design, datainnsamling, analyse og tolkning av data samt utarbeiding og revisjon av manuset. Kristian Jostad Henriksveen er cand.med. Forfa eren har fylt ut ICMJE-skjemaet og oppgir ingen interessekonflikter. NTNU og Kirurgisk klinikk St. Olavs hospital Forfa erbidrag: idé, utforming/design, analyse og tolkning av data samt revisjon av manuset. Alex J. van Duinen er ph.d., spesialist i generell kirurgi og lege i spesialisering i gastroenterologisk kirurgi. Forfa eren har fylt ut ICMJE-skjemaet og oppgir ingen interessekonflikter. Aku e laparotomier ved St. Olavs hospital | Tidsskrift for Den norske legeforening n (%) 30 dagers mortalitet, n (%) Diuretika eller antihypertensiver 343 (36,5) 40 (11,7) Perifere ødemer/antikoagulantia 90 (9,6) 13 (14,4) Kardiomegali 3 (0,3) 2 (66,7) Respiratorisk status Ingen dyspné 773 (82,3) 53 (6,9) Kols grad 1-2 115 (12,3) 12 (10,4) Kols grad 3 37 (3,9) 9 (24,3) Kols grad 4 14 (1,5) 3 (21,4) ASA-klassifisering ASA-klasse 1 10 (1,1) 0 (0,0) ASA-klasse 2 187 (19,9) 1 (0,5) ASA-klasse 3 493 (52,6) 21 (4,3) ASA-klasse 4 241 (25,7) 51 (21,2) ASA-klasse 5 7 (0,8) 4 (57,1)

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“…EL is recognized as high‐risk surgery associated with high rates of morbidity and mortality. The mean 30‐, 90‐ and 365‐day mortality worldwide is reported to be 8.4%, 14.1% and 24.6%, respectively 2 …”

Section: Introductionmentioning

confidence: 99%

“…The mean 30-, 90-and 365-day mortality worldwide is reported to be 8.4%, 14.1% and 24.6%, respectively. 2 EL is challenging for many reasons, including the decompensated physiology of an acute illness, the heterogeneity of surgical pathologies, and the diversity of patients' pre-operative health. Effectively predicting outcomes and being able to quantify risks are important to clinical decision-making.…”

Section: Introductionmentioning

confidence: 99%

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Sarcopenia ‘made simple’ and outcomes from emergency laparotomy

Ming

Howley

Holmes

et al. 2022

ANZ Journal of Surgery

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Background: Emergency Laparotomy (EL) is recognized as high-risk surgery with high mortality. Established surgical risk assessment tools (NELA Risk Prediction Calculator, P-POSSUM, ACS-NSQIP) are accurate predictors of morbidity and mortality. However, their multicomponent complexity limits their use in practice. Sarcopenia is associated with poorer surgical outcomes. This study tests for an association between a simple measure of radiological sarcopenia and mortality in EL patients in an Australian cohort. Methods: A retrospective analysis was conducted of 500 patients admitted to four Australian hospitals who underwent EL during 2016-2017. All patients had a contemporaneous abdomino-pelvic CT scan. Radiological sarcopenia was measured as the ratio of total psoas muscle area (PM) to L3 vertebral body cross sectional area (PM:L3). Patients were followed up to 12 months. Primary outcomes were 30-, 90-and 365-day mortality. Results: The mean 30-day mortality predictions for NELA, P-POSSUM and ACS-NSQIP were 11.36%, 17.28% and 11.30% respectively. PM:L3 ratio was associated with 30-, 90-and 365-day mortality (P < 0.001) and sex (P < 0.001) and negatively correlated with age (r = À0.4612; P < 0.001). Radiological sarcopenia had a weak negative correlation with NELA (r = À0.2737; P < 0.001), P-POSSUM (r = À0.1880; P < 0.001) and ACS-NSQIP (r = À0.2351; P < 0.001). The latter three metrics were significantly correlated (r > 0.5696; P < 0.001). Conclusion: Radiological sarcopenia (CT-assessed PM:L3) is a significant predictor of mortality in EL patients in Australia. The results of this study suggest that radiological sarcopenia is equivalent to established risk assessment tools. The more timely and easily accessible CT-assessed PM: L3 metric is potentially automatable and may have significant utility in clinical practice.

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New Zealand and Australia emergency laparotomy mortality rates compare favourably to international outcomes: a systematic review

Cited by 16 publications

References 38 publications

Effect of sarcopenia in predicting postoperative mortality in emergency laparotomy: a systematic review and meta-analysis

Effect of sarcopenia in predicting postoperative mortality in emergency laparotomy: a systematic review and meta-analysis

Emergency laparotomy at St Olav's Hospital, Trondheim

Sarcopenia ‘made simple’ and outcomes from emergency laparotomy

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