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

Abstract

Background Emergency laparotomy (EL) is accompanied by high post-operative morbidity and mortality which varies significantly between countries and populations. The aim of this study is to report outcomes of emergency laparotomy in Greece and to compare them with the results of the National Emergency Laparotomy Audit (NELA). Methods This is a multicentre prospective cohort study undertaken between 01.2019 and 05.2020 including consecutive patients subjected to EL in 11 Greek hospitals. EL was defined according to NELA criteria. Demographics, clinical variables, and post-operative outcomes were prospectively registered in an online database. Multivariable logistic regression analysis was used to identify independent predictors of post-operative mortality. Results There were 633 patients, 53.9% males, ASA class III/IV 43.6%, older than 65 years 58.6%. The most common operations were small bowel resection (20.5%), peptic ulcer repair (12.0%), adhesiolysis (11.8%) and Hartmann’s procedure (11.5%). 30-day post-operative mortality reached 16.3% and serious complications occurred in 10.9%. Factors associated with post-operative mortality were increasing age and ASA class, dependent functional status, ascites, severe sepsis, septic shock, and diabetes. HELAS cohort showed similarities with NELA patients in terms of demographics and preoperative risk. Post-operative utilisation of ICU was significantly lower in the Greek cohort (25.8% vs 56.8%) whereas 30-day post-operative mortality was significantly higher (16.3% vs 8.7%). Conclusion In this study, Greek patients experienced markedly worse mortality after emergency laparotomy compared with their British counterparts. This can be at least partly explained by underutilisation of critical care by surgical patients who are at high risk for death. Supplementary Information The online version contains supplementary material available at 10.1007/s00268-022-06723-6.

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

“…To put in a nutshell, we believe that the results of the study by Lasithiotakis et al [1] should act as an alarm for the Greek Health System, highlighting the need for urgent reforms in order to improve the quality of the provided acute care surgery. Under this notion, the sequential NELA audits could act as a guide and an example for the Greek authorities to follow, especially taking into account the presence of many Greek surgeons, who have worked in both systems and could help towards this direction both organizationally and clinically.…”

“…We read with great interest the study entitled ''The Hellenic Emergency Laparotomy Study (HELAS): A Prospective Multicentre Study on the Outcomes of Emergency Laparotomy in Greece'', by Lasithiotakis et al [1], which in our opinion was exceptional attempt to audit the quality and outcomes of emergency surgical care in Greece. We believe that the results of the study truly reflect our anecdotal experiences and perceptions regarding the problems in various aspects of perioperative care and-if taken into appropriate consideration-could have a positive impact on the organization and delivery of acute care surgery in Greece.…”

Prospective multicenter external validation of postoperative mortality prediction tools in patients undergoing emergency laparotomy

“…Case ascertainment rate was high, and it has been described in detail in the report of the Hellenic Emergency Laparotomy Study. 15 The patients had a mean age of 66 years (range, 19-99 years), 54% were male, and 43% were classified as American Society of Anesthesiologists status III/IV. The most common indication for EL was gastrointestinal obstruction (39%), followed by perforation (36%) and ischemia (15%).…”

“…Previous reports have revealed significant differences in the management of EL in this population compared with the United Kingdom. 15,16 The present study performed comparative external validation of four common risk prediction tools (ACS-NSQIP, NELA, P-POSSUM, and POTTER), in a multicenter prospective cohort design, to identify the best tool for predicting 30-day mortality in Greek patients undergoing EL.…”

NELA, HELAS and Quality of Care

“…A South African study using a modified NELA audit tool identified trauma emergency laparotomy patients to have worse outcomes compared to non-trauma emergency laparotomy patients treated by General Surgeons although they both use the same care pathway [3]. The Hellenic Emergency Laparotomy Study (HELAS) study is the latest using the NELA audit tool [4].…”