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Intraoperative Surgical Strategy in Abdominal Emergency Surgery

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Abstract

Background

Emergency abdominal surgery is associated with a high rate of postoperative complications and death. Pre- and immediate postoperative bundle-care strategies have improved outcome, but so far, no standardized intraoperative strategies have been proposed. We introduced a quality improvement model of specific intra- and postoperative strategies for the heterogenous group of patients undergoing emergency abdominal surgery. The objective was to evaluate a quality improvement strategy, using an intraoperative, multidisciplinary time-out model in emergency abdominal surgery to apply one of three surgical strategies; definitive–palliative–or damage control surgery.

Methods

All patients scheduled for any gastrointestinal emergency procedure were stratified dynamically according to standardized criteria for performing definitive–palliative–or damage control surgery. Pre- intra- and postoperative data were collected according to the intraoperative strategy applied. Postoperative complications were displayed according to the Clavien-Dindo-score and the CCI (Comprehensive Complication Index). 30–90-day- and 1-year mortality was presented.

Results

We included 436 consecutive patients undergoing emergency laparotomy or laparoscopy in 2019. Intraoperative strategy was definitive in 326(75%)–palliative in 90(21%) and damage control approach in 20(4%) patients. CCI was 21(0,45), 30(17,54) and 78(54,100) in the definitive–, the palliative–, and the damage control group, respectively. 30-day mortality was; 11.7%, 26.7% and 30%, and the 1-year mortality was 16.9%, 56.7% and 40% in the definitive– the palliative– and the damage control group, respectively.

Conclusions

We present a multidisciplinary, intraoperative decision-making standard as a potential quality improvement tool of ensuring individualized intra- and postoperative treatment for every emergency surgical patient and for future research-protocols.

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Funding

This study was not supported by any funding.

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Authors and Affiliations

  1. Department of Gastrointestinal Surgery, Copenhagen University Hospital Hilleroed, Hilleroed, Denmark

    Mai-Britt Tolstrup

  2. Department of Gastrointestinal Surgery, Copenhagen University Hospital Herlev, Herlev, Denmark

    Thomas Korgaard Jensen

  3. Department of Gastrointestinal Surgery, Copenhagen University Hospital Roskilde and Koege, Roskilde, Denmark

    Ismail Gögenur

Authors
  1. Mai-Britt Tolstrup
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  2. Thomas Korgaard Jensen
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  3. Ismail Gögenur
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Correspondence to Mai-Britt Tolstrup.

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Tolstrup, MB., Jensen, T.K. & Gögenur, I. Intraoperative Surgical Strategy in Abdominal Emergency Surgery. World J Surg 47, 162–170 (2023). https://doi.org/10.1007/s00268-022-06782-9

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