Post-Operative Complications Following Emergency Laparotomy are Common and Associated with increased Late Mortality - A Retrospective Multi-Centre study

Emergency abdominal surgery, often termed emergency laparotomy, is a common surgical procedure undertaken in the United Kingdom (U.K), with approximately 30000 procedures annually. Patients presenting for emergency abdominal surgery are heterogeneous and present with diverse pathology, resulting in challenges for the surgical, anaesthetic and critical care team that manage them. Emergency laparotomy, by its very nature is high-risk surgery, with an estimated 30-day mortality in the U.K of 11%, which is over 10 times greater than the mortality of patients undergoing major elective surgery (e.g. cardiac, vascular and oncological surgery) and a median hospital length of stay (LOS) of 12-days. Risk factors associated with poorer outcomes from emergency laparotomy have been identified by the National Emergency Laparotomy Audit (NELA) and include advancing age, with each decade above the age of 50 being associated with increasing risk. Additional risk factors include an American Society of Anaesthesia (ASA) status of 3 or more and Portsmouth- Physiological and Operative Severity Score for the enumeration of Mortality and morbidity (P-POSSUM) risk of death of greater than 5%. The development of post-operative pulmonary complications (PPCs) is a composite definition for a variety of respiratory complications that occur following surgery. They range from clinically significant bronchospasm and atelectasis, through to the development of pneumonia and the acute respiratory distress syndrome (ARDS). The incidence following elective major abdominal surgery has been estimated at 11.9% and is associated poorer outcomes with increased length of hospital stay, increased re-admissions and a higher mortality. Although emergency surgery is well established as a significant risk factor for the development of PPCs, the incidence is not well established. This study aimed to establish the incidence of PPCs in a cohort of patients undergoing emergency laparotomy and the consequences on patient outcomes.