What is the clinical evidence from this study?

Study design: Cohort. Population: Acute abdominal condition requiring emergency laparotomy (n=663). Intervention: Emergency laparotomy. Primary outcome: 30-day mortality.

August 11, 2021Open Access

Mortality following emergency laparotomy: a Swedish cohort study

TTTerje Jansson TimanNU Hospital Group GHGustav HagbergNU Hospital Group NSNinni SernertNU Hospital Group

Key Result

Emergency laparotomy was associated with a 30-day mortality rate of 14.2% and a 1-year mortality rate of 26.6% in a Swedish cohort.

Study Design

Type

Cohort (n=663)

Multicenter

Structured PICO

Population

663 adult patients undergoing 710 emergency laparotomies for acute abdominal conditions at a single Swedish center, followed for up to 1 year.

Exposure

Emergency laparotomy (EL)

Outcome

Short-term mortality (within 30 days from the first incision)hard clinical

Emergency laparotomy in a Swedish cohort is associated with high short-term (14.2%) and long-term (26.6%) mortality, strongly correlated with existing comorbidity and ICU admission.

Limitations

Single-centre study, which risks giving data less external validity
Retrospective data collection from medical records
Long study period (over 3 years) with potential changes in treatment
No multivariate analysis performed for the significant results

Abstract

BACKGROUND: Emergency 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. METHODS: Medical 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. RESULTS: A 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. CONCLUSIONS: In 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).

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