Abstract
Introduction
Emergency laparotomy (EL) is a commonly performed operation with increased morbidity and mortality. Currently, there is a lack of published outcomes following emergency laparotomy within an Irish population. The aim of this study was to assess our outcomes and compare these to predefined outcomes from NELA.
Methods
A review of a prospectively maintained database of all patients who underwent an emergency laparotomy between January 1st 2015 and October 31st 2016 was performed. Patient demographics, operative indication and procedures, preoperative lactate, time of surgery, admission to high dependency unit (HDU) and mortality (30- and 90-day mortality) were included. Statistical analysis was performed using Minitab V18 with p < 0.05 considered significant.
Results
One hundred twenty-four emergency operations were performed on 120 patients. The median age was 60 years. Indications for surgery included the following (%): peritonitis (32.45%), obstruction (22.5%), complicated hernia (19.1%), mesenteric ischaemia (15%), trauma (4.1%), and acute haemorrhage (3.3%). A consultant surgeon and consultant anaesthetist were present at 79 and 78% of EL carried out, respectively. Reported 30- and 90-day mortality were 6.66 and 11.6%, respectively. Thirty-day mortality was 20% in octogenarians. Index lactate did not correlate with mortality (p = 0.43). A significant proportion of mortalities had procedures carried out between 6 pm and midnight with the highest mortality rate in patients with mesenteric ischaemia (p < 0.05).
Conclusion
EL is associated with high mortality rates. Our mortality figures compare favourably with the NELA data. We support the development of a national database to facilitate improvements in the quality of care delivered to this high-risk cohort.
Similar content being viewed by others
References
Association of Surgeons of Great Britain and Ireland (2007) Emergency general surgery: the future—a consensus statement. ASGBI, London
Saunders DI, Murray D, Pichel AC, Varley S, Peden CJ (2012) Variations in mortality after emergency laparotomy: the first report of the UK Emergency Laparotomy Network. Br J Anaesth (England) 109(3):368–375. https://doi.org/10.1093/bja/aes165
Model of care for acute surgery 2013, National Clinical Programme in Surgery. Joint leads Professor Frank Keane, Mr. Ken Mealy. Published 2013
NELA (2015) The first patient report of the national emergency laparotomy audit. Royal College of Anaesthetists, London
Central Statistics Office (CSO) (2016) Census of population 2016—profile 3 an age profile of Ireland http://www.cso.ie/en/release and publications/ep/p-cp3oy/cp3: CSO
National Confidential Enquiry into Patient Outcome and Death (NCEPOD) (2010) An age old problem: a review of the care received by elderly patients undergoing surgery. www.nce pod.org.uk/2010report3/downloads/EESE_fullReport.pdf: NCE- POD; 2010
Sharrock AE, McLachlan J, Chambers R, Bailey IS, Kirkby-Bott J (2017) Emergency abdominal surgery in the elderly: can we predict mortality? World J Surg 41(2):402–409. https://doi.org/10.1007/s00268-016-3751-3
Quiney N, Huddart S, Peden C, Dickinson M (2015 Jun) Use of a care bundle to reduce mortality following emergency laparotomy. Br J Hosp Med (Lond) 76(6):358–362. https://doi.org/10.12968/hmed.2015.76.6.358
Huddart S1, Peden CJ, Swart M, McCormick B, Dickinson M, Mohammed MA, Quiney N, ELPQuiC Collaborator Group, ELPQuiC Collaborator Group (2015) Use of a pathway quality improvement care bundle to reduce mortality after emergency laparotomy. Br J Surg 102(1):57–66
Gibbons JP, Nugent E, Tierney S, Kavanagh D (2016 Feb) Implementation of a surgical handover tool in a busy tertiary referral centre: a complete audit cycle. Ir J Med Sci 185(1):225–229. https://doi.org/10.1007/s11845-015-1278-5
Emergency surgery performance and quality outcome consensus summit, Donegal Ireland 2016, Sugrue M, Maier R
National office of clinical audit. www.NOCA.ie . 2015
Studer P, Vaucher A, Candinas D, Schnüriger B (2015) The value of serial serum lactate measurements in predicting the extent of ischemic bowel and outcome of patients suffering acute mesenteric ischemia. J Gastrointest Surg 19(4):751–755. https://doi.org/10.1007/s11605-015-2752-0
Demir IE, Ceyhan GO, Friess H (2012) Beyond lactate: is there a role for serum lactate measurement in diagnosing acute mesenteric ischemia. Dig Surg 29(3):226–235. https://doi.org/10.1159/000338086
Kruse O, Grunnet N, Barfod C (2011) Blood lactate as a predictor for in-hospital mortality in patients admitted acutely to hospital: a systematic review. Scand J Trauma Resusc Emerg Med 19:74
Verma I, Kaur S, Goyal S, Goyal S, Multani JS, Narang APS (2014 Jul) Diagnostic value of lactate levels in acute abdomen disorders. Indian J Clin Biochem 29(3):382–385
Buck N, Devlin HB, Lunn JN (1988) Report by the national confidential enquiry into perioperative deaths. Nuffield Provincial Hospitals Trust, London
McIsaac DI, Abdulla K, Yang H, Sundaresan S, Doering P, Vaswani SG, Thavorn K, Forster AJ (2017 Jul 10) Association of delay of urgent or emergency surgery with mortality and use of health care resources: a propensity score-matched observational cohort study. CMAJ 189(27):E905–E912. https://doi.org/10.1503/cmaj.160576
Campling EA, Devlin HB, Lunn JN. The report of the National Confidential Enquiry into Perioperative Deaths 1989. NCEPOD, London 1990 (see: www.ncepod.org.uk/)
Campling EA et al. The report of the National Confidential Enquiry into Perioperative Deaths 1992/1993. NCEPOD, London 1995 (see: www.ncepod.org.uk/)
Buck N, Devlin HB, Lunn JN (1988) Report by the National Confidential Enquiry into Perioperative Deaths. Nuffield Provincial Hospitals Trust, London
Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, Seeman T, Tracy R, Kop WJ, Burke G, McBurnie MA (2001) Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 56(3):M146–M156. https://doi.org/10.1093/gerona/56.3.M146
The third patient report of the national emergency laparotomy audit October 2017. http://www.nela.org.uk/reports
Cook TM, Day CJE (1998) Hospital mortality after urgent and emergency laparotomy in patients aged 65 and over. Risk and prediction of risk using multiple logistical regression analysis. Br J Anaesth 80(6):776–781. https://doi.org/10.1093/bja/80.6.776
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Kiernan, A.C., Waters, P.S., Tierney, S. et al. Mortality rates of patients undergoing emergency laparotomy in an Irish university teaching hospital. Ir J Med Sci 187, 1039–1044 (2018). https://doi.org/10.1007/s11845-018-1759-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11845-018-1759-4