Key result
Emergency abdominal exploration for complications of elective surgery was associated with a significantly lower in-hospital mortality rate (31.1%) compared to exploration for primary high-risk emergencies (38.0%).
Why the study?
Emergency surgical abdominal exploration carries high mortality exceeding 20%, but differences in outcomes between complications of elective procedures versus primary emergencies were uncharacterized.
Does emergency surgical abdominal exploration for complications of elective surgery result in lower in-hospital mortality compared to exploration for primary high-risk abdominal emergencies in adults?
Cohort (n=1,069)
No
Does emergency surgical abdominal exploration for complications of elective surgery result in lower in-hospital mortality compared to exploration for primary high-risk abdominal emergencies in adults?
Relative Risk: 1.09 (95% CI 1.01–1.17)
Absolute Event Rate: 31.1% vs 38%
p-value: p=0.035
Patients undergoing emergency abdominal exploration for complications of elective surgery have significantly lower in-hospital mortality and complication burden compared to those with primary high-risk abdominal emergencies.
May inform risk discussions for re-exploration versus primary emergencies; leaves open whether selection bias drives the observational difference.
Irrespective of its etiology, emergency surgical abdominal exploration (EAE) is considered a high-risk procedure with mortality rates exceeding 20%. The aim of this study was to evaluate differences in outcomes in patients who required EAE due to complications of complex elective abdominal procedures and those who required EAE due to high-risk primary abdominal emergencies. Patients undergoing EAE for acute surgical complications of complex abdominal elective surgical procedures (N = 293; Elective group) and patients undergoing EAE for high-risk primary abdominal emergencies (N = 776; Emergency group) from 2012 to 2019 at our institution were retrospectively assessed for morbidity and mortality. Postoperative complications occurred in 196 patients (66.94%) in the elective group and 585 patients (75.4%) in the emergency group. The relatively low complication burden in the elective group was also evidenced by a significantly lower comprehensive complication index score (54.00 ± 37.36 vs. 59.25 ± 37.08, p = 0.040). The in-hospital mortality rates were 31% (91 of 293) and 38% (295 of 776) in the elective and emergency groups, respectively. This difference between the two groups was statistically significant (p = 0.035). In multivariate analysis, age, peripheral artery disease, pneumonia, thromboembolic events, ICU stay, ventilator dependence, acute kidney failure and liver failure were independent predictors of mortality. Our data show that patients undergoing EAE due to acute complications of major elective surgery tolerate the procedure relatively well compared with patients undergoing EAE due to primary high-risk abdominal emergencies.
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Kassahun et al. (2022) conducted a cohort in Major abdominal emergencies requiring emergency surgical abdominal exploration (n=1,069). Emergency abdominal exploration for complications of elective surgery vs. Emergency abdominal exploration for primary high-risk emergencies was evaluated on In-hospital mortality (RR 1.09, 95% CI 1.01-1.17, p=0.035). Emergency abdominal exploration for complications of elective surgery was associated with a significantly lower in-hospital mortality rate (31.1%) compared to exploration for primary high-risk emergencies (38.0%).
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