Key result
Nontrauma emergency laparotomy had an overall 30-day mortality rate of 6.8%, with significant predictors including low GFR, COPD, blood transfusion, and ICU admission.
Why the study?
Emergency laparotomy often lacks preoperative optimization due to its urgent nature and has a reported mortality rate of up to 44%, prompting an examination of mortality at an academic acute care surgery center.
What are the predictors of 30-day mortality in adult patients undergoing emergency laparotomy in nontrauma settings?
Cohort (n=234)
No
What are the predictors of 30-day mortality in adult patients undergoing emergency laparotomy in nontrauma settings?
Emergency laparotomy in nontrauma settings can be performed with a lower 30-day mortality (6.8%) than previously reported, with specific preoperative and perioperative factors predicting mortality risk.
May guide risk stratification in nontrauma emergency laparotomy; leaves open whether modifying these factors improves survival.
INTRODUCTION: Emergency laparotomy (EL) is a common operation that deals with a wide range of pathologies. Preoperative optimization is often lacking due to the urgent nature of the disease process with a reported mortality rate of up to 44%. This study examines the mortality of EL at an academic acute care surgery medical center. METHODS: A retrospective analysis of nontrauma EL from January 2008 to December 2013 was conducted. Data included demographics, clinical features, preoperative laboratory studies, comorbidities, time to surgery, ICU admission, and 30-day mortality. RESULTS: A total of 234 patients (123 males, 52.6%) were included in the study. EL was performed within four hours (immediate) of presentation in 93 (39.7%) patients, within 4-12 hours (early) in 53 (25.4%) patients, and within 12-24 hours (late) in 63 (30.1%) patients. Overall mortality was 16 (6.8%) at 30 days. Mortality was significantly higher with chronic obstructive pulmonary disease (p = 0.014), blood transfusion (p < 0.001), ICU admission (p < 0.001), ventilator days > four (p = 0.013), hyperlipidemia (p = 0.014), heart rate > 90 beats/minute (p = 0.003), temperature > 38°C or < 35°C (p = 0.013), and systolic blood pressure < 90 mmHg (p < 0.001). CONCLUSION: EL can be performed with lower mortality than previously reported. Specific predictors of mortality are identified and can be used for risk assessment.
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Dolman et al. (2022) conducted a cohort in Nontrauma emergency laparotomy (n=234). Emergency laparotomy was evaluated on 30-day mortality. Nontrauma emergency laparotomy had an overall 30-day mortality rate of 6.8%, with significant predictors including low GFR, COPD, blood transfusion, and ICU admission.
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