A. D. Shahait1, A. D. Hollenbeck1, D. Kristl1, H. Dolman1, J. D. Tyburski1, G. Mostafa1 1Wayne State University,General Surgery,Detroit, MI, USA
Introduction: Emergency laparotomy (ER) 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. Multiple studies have shown a mortality rate of 14% in ER compared to 1.5-9.8% in elective operations. In this study, we review the outcome of ER at our academic acute care surgery center.
Methods: A retrospective analysis of all adult patients who underwent non-trauma ER, between January 2008 to December 2013 was conducted. Data included; demographics, clinical features, preoperative laboratory, comorbidities, time to surgery, ICU admission, and 30 & 90 days mortality.
Results: A total of 234 patients [123 male (52.6%), 111 female (47.4%)] were included. ER was performed within 4 hours (immediate) of presentation in (93) 39.7% ,within 4-12 hours (early) in (53) 25.4%, and within 12-24 hours (late) in (63) 30.1% of patients. Overall mortality was (16) 6.8%, and (15) 6.4% at 30 and 90 days, respectively. Both 30-day and 90-day mortality were significantly higher with chronic obstructive pulmonary disease (p=0.014), blood transfusion (p <0.001), ICU admission (p<0.001), Ventilator days > 4 (p=0.013), hyperlipidemia (p=0.014), heart rate > 90 beat/minute (p=0.003), temperature >38 C or <35 C (p=0.013) and Systolic blood pressure < 90 mmHg (p<0.001). The timing of surgery, gender, age >75 years, ethnicity, cardiovascular diseases, smoking, and body mass index had no impact on mortality.
Conclusion: ER can be performed with lower mortality than previously reported. Specific predictors of mortality are identified that could improve optimization and be used for risk assessment.