Mortality following emergency laparotomy: a Swedish cohort study

BMC Surgery

Ove Karlsson¹  Ninni Sernert²  Terje Jansson Timan³  Mattias Prytz⁴  Gustav Hagberg⁵ 

[1] Department of Anesthesiology and Intensive Care Unit, NU-Hospital Group, Trollhättan, Sweden;Department of Anesthesiology and Intensive Care, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden;Department of Research and Development, NU-Hospital Group, Trollhättan, Sweden;Department of Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden;Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden;Department of Research and Development, NU-Hospital Group, Trollhättan, Sweden;Department of Anesthesiology and Intensive Care Unit, NU-Hospital Group, Trollhättan, Sweden;Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden;Department of Research and Development, NU-Hospital Group, Trollhättan, Sweden;Department of Surgery, NU-Hospital Group, Trollhättan, Sweden;Department of Surgery, NU-Hospital Group, Trollhättan, Sweden;

关键词: Acute surgery;    Emergency laparotomy;    Acute abdomen;    Outcome;    Mortality;    Intensive care;    ICU;    Perioperative management;   

DOI  :  10.1186/s12893-021-01319-8

来源: Springer

【 摘 要 】

BackgroundEmergency laparotomy (EL) is a central, high-risk procedure in emergency surgery. Patients in need of an EL present an acute pathology in the abdomen that must be operated on in order to save their lives. Usually, the underlying condition produces an affected physiology. The perioperative management of this critically ill patient group in need of high-risk surgery and anaesthesia is challenging and related to high mortality worldwide. However, outcomes in Sweden have yet to be studied. This retrospective cohort study explores the perioperative management and outcome after 710 ELs by investigating mortality, overall length of stay (LOS) in hospital, need for care at the intensive care unit (ICU), surgical complications and a general review of perioperative management.MethodsMedical records after laparotomy was retrospectively analysed for a period of 38 months (2014–2017), the emergency cases were included. Children (< 18 years), aortic surgery, second look and other expected reoperations were excluded. Demographic, management and outcome data were collected after an extensive analysis of the cohort.ResultsA total of 710 consecutive operations, representing 663 patients, were included in the cohort (mean age 65.6 years). Mortality (30 days/1 year) after all operations was 14.2% and 26.6% respectively. The mean LOS in hospital was 12 days, while LOS in the ICU was five days. Of all operations, 23.8% patients were admitted at any time to the ICU postoperatively and the 30-day mortality seen among ICU patients was 37.9%. Mortality was strongly correlated to existing comorbidity, high ASA classification, ICU care and faecal peritonitis. The mean/median time from notification to operate until the first incision was 3:46/3:02 h and 87% of patients had their first incision within 6 h of notification.ConclusionsIn this present Swedish study, high mortality and morbidity were observed after emergency laparotomy, which is in agreement with other recent studies.Trial registration: The study has been registered with ClinicalTrials.gov (NCT03549624, registered 8 June 2018).

【 授权许可】

CC BY