Perioperative factors associated with postoperative morbidity after emergency laparotomy: a retrospective analysis in a university teaching hospital

Abstract

Emergency Laparotomy (EL) is associated with significant morbidity and mortality. Variation in practice and patient outcomes for patients undergoing emergency laparotomy has been identified through the UK National Emergency Laparotomy Audit (NELA), with 30-day mortality ranging from 11 to 15%. A correlation between preoperative haemodynamic parameters and increased postoperative mortality has been demonstrated by both NELA and other observational studies. The association between intraoperative haemodynamic parameters and overall postoperative morbidity has not been evaluated in EL patients. The aims of our study were to investigate the association between perioperative haemodynamic and logistic parameters and postoperative morbidity in a tertiary referral university hospital; and to compare our outcomes to that of the NELA data. A retrospective analysis correlating a range of perioperative parameters with Comprehensive Complication Index (CCI) among 86 patients who underwent EL during 2018 was conducted. Mean age was 64 years (SD 16). Median CCI was 27 [9–45], and 30-day mortality was 11.7%. Several intraoperative parameters correlated with CCI on univariate analysis. On multivariate analysis, ASA status (P = 0.005) and unplanned escalation to postoperative intensive care (P = 0.03) were independently associated with CCI. Our study shows a correlation between ASA status and unplanned escalation to ITU with increased postoperative morbidity in patients undergoing emergency laparotomy. We did not demonstrate an independent correlation between intraoperative parameters and postoperative morbidity. These findings warrant confirmation in a larger scale observational study. Outcomes in our institution are comparable to those seen in the NELA.

Magnitude of in-hospital mortality and its associated factors among patients undergone laparotomy at tertiary public hospitals, West Oromia, Ethiopia, 2022

“…Patients admitted to the intensive care unit while in hospital were nearly ve times more likely to die than those not admitted to the ICU. This nding is supported by studies conducted in different parts of the world: South Africa (28), Rwanda (50), UK (39), Singapore (40), Ireland (42), Netherland (7), and China (51).…”

“…Assessment of patient age and physical condition ASA may help improve surgical intervention to improve outcomes (36). This nding is supported by studies done in Malawi (12), UK (37)(38)(39), Singapore (40), USA (33) ,Turkey (41) and Ireland, (42). The possible explanation for this consistency is that, patients ASA status contributes to reduced physiological reserve and that the negative effect of underlying abdominal pathology may contributes to an increased risk of postoperative mortality in patients undergone laparotomy (43).…”

The Hellenic Emergency Laparotomy Study (HELAS): A Prospective Multicentre Study on the Outcomes of Emergency Laparotomy in Greece

“…Not every possible risk factor was captured but only well recognised ones from the literature. We did not include intraoperative haemodynamic parameters, volumes of fluids, transfusions of blood products and vasoconstrictors which have been associated with post-operative morbidity in other reports [ 18 ]. Therefore, unmeasured characteristics of the patients, the diseases or system processes may potentially explain the variation observed in mortality.…”

Assessment of the Use of Spinal Anesthesia for laparotomy: A Survey among French-speaking anesthetists

“…Emergency laparotomy is a surgical procedure widely used for many intra-abdominal pathologies. It's a very complex situation that involves time of practitioners, great socio-economic cost and has a high morbidity and mortality rate [1][2][3] . Eighty-five percent of patients who undergo emergency laparotomy have an acute, lifethreatening condition while the laparotomy itself is a high-risk surgical procedure 2 .…”

“…It's a very complex situation that involves time of practitioners, great socio-economic cost and has a high morbidity and mortality rate [1][2][3] . Eighty-five percent of patients who undergo emergency laparotomy have an acute, lifethreatening condition while the laparotomy itself is a high-risk surgical procedure 2 . Around 175,000 laparotomies are performed annually in the USA and around 30,000 to 50,000 emergency laparotomies are performed annually in the UK with a variety of surgical etiologies 4,5 .…”