The Emergency Laparotomy Protocol: A Retrospective Cohort Study of Morbidity and Mortality After the Introduction of a Perioperative Protocol for Emergency Laparotomies

Background Emergency laparotomy and its perioperative care is associated with high morbidity and mortality. At our institution, 30‐day mortality was approximately 12% in 2013–2017. We introduced a perioperative protocol for emergency laparotomies in 2019. Method Retrospective cohort of emergency laparotomies 2019–2022. Reoperations, trauma and converted laparoscopies (appendectomy and cholecystectomy) were excluded. Primary outcome was mortality at 30, 90, and 180 days. Secondary outcomes were postoperative complications (Clavien–Dindo; CD) and hospital‐based outcomes. Results Six hundred eighty‐two patients undergoing emergency laparotomy were included. Age was 72 (IQR 23) years and 66.4% ( n = 453) were aged ≥ 65 years 56.6% ( n = 386) were ASA class III or IV and 6.5% ( n = 44) were not living at home at admission. The most frequent surgical findings were bowel obstruction (64.2%; n = 438) and gastrointestinal perforations ( n = 134; 19.4%). Stoma creation (29.9%; n = 204), adhesiolysis (28.6%; n = 195), and anastomosis (27.4%; n = 187) were common. Mortality at 30 days was 6.9% ( n = 47), 90 days 11.0% ( n = 75), and 180 days 12.8% ( n = 87). Mortality was higher for patients ≥ 80 years than < 65 years (23.9% vs. 4.4%; p < 0.001). Mortality predictors were admission not from home ( p = 0.043), disseminated cancer ( p < 0.001), and septic shock ( p = 0.003) or systemic inflammatory response syndrome ( p = 0.017). CD IIIb–IVb occurred in 81 patients (11.9%). ICU admission was 16.6% ( n = 113) and LOS 8 (IQR 7) days. Conclusions Mortality and complication rates after the introduction of a perioperative emergency laparotomy protocol were low despite a comorbid aged‐patient cohort. Particular focus on the elderly, frail, and septic patients considered for emergency laparotomy is recommended.