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Morbidity and mortality rates after emergency abdominal surgery: an analysis of 4346 patients scheduled for emergency laparotomy or laparoscopy

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Abstract

Purpose

Emergency abdominal surgery results in a high rate of post-operative complications and death. There are limited data describing the emergency surgical population in details. We aimed to give a detailed analyses of complications and mortality in a consecutive group of patients undergoing acute abdominal surgery over a 4-year period.

Methods

This observational study was conducted between 2009 and 2013 at Copenhagen University Hospital Herlev, Denmark. All patients scheduled for emergency laparotomy or laparoscopy were included. Pre-, intra-, and post-operative data were collected from medical records. Complications were registered according to the Clavien-Dindo classification. Cox regression analysis was performed to identify risk factors for mortality.

Results

A total of 4,346 patients underwent emergency surgery, of whom 14 % had surgical complications and 23 % medical complications. The overall 30-day mortality was 8 % with 50 % of those in this group over 80 years of age. The 30-day mortality rates were 0.8 % (95 % CI 0.5–1.1) and 17 % (95 % CI 15.5–18.9), respectively, for the laparoscopy and the laparotomy groups. The overall death rate within 24 h of surgery was 21 %. Several risk factors for 30- and 90-day mortality were identified: age, ASA ≥3 (American Society of Anaesthesiologists physical status classification), performance score (Zubroed/WHOclassification), cirrhosis of the liver, chronic nephropathy, several medical conditions, and malignancy.

Conclusion

Almost one in five patients died after emergency laparotomy, of whom one in five died within 24 h of surgery. Predictors for poor outcome were identified.

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References

  1. Saunders DI, Murray D, Pichel AC et al (2012) Variations in mortality after emergency laparotomy: the first report of the UK Emergency Laparotomy Network. Br J Anaesth 109:368–375. doi:10.1093/bja/aes165

    Article  CAS  PubMed  Google Scholar 

  2. Clarke A, Murdoch H, Thomas MJ et al (2011) Mortality and postoperative care after emergency laparotomy. Eur J Anaesthesiol 28:16–19. doi:10.1097/EJA.0b013e32833f5389

    Article  PubMed  Google Scholar 

  3. Pearse RM, Harrison DA, James P et al (2006) Identification and characterisation of the high-risk surgical population in the United Kingdom. Crit Care 10:R81. doi:10.1186/cc4928

    Article  PubMed  PubMed Central  Google Scholar 

  4. Stoneham M, Murray D, Foss NB (2013) Emergency surgery: the big three—abdominal aortic aneurysm, laparotomy and hip fracture. Anaesthesia 69:70–80. doi:10.1111/anae.12492

    Article  Google Scholar 

  5. Al-Temimi MH, Griffee M, Enniss TM et al (2012) When is death inevitable after emergency laparotomy? Analysis of the American College of Surgeons National Surgical Quality Improvement Program Database. J Am Coll Surg 215:503–511. doi:10.1016/j.jamcollsurg.2012.06.004

    Article  PubMed  Google Scholar 

  6. Davis KA, Rozycki GS (2010) Acute care surgery in evolution. Crit Care Med 38:S405–S410. doi:10.1097/CCM.0b013e3181ec55c8

    Article  PubMed  Google Scholar 

  7. Ball CG, MacLean AR, Dixon E et al (2012) Acute care surgery: the impact of an acute care surgery service on assessment, flow, and disposition in the emergency department. Am J Surg 203:578–583. doi:10.1016/j.amjsurg.2011.12.006

    Article  PubMed  Google Scholar 

  8. The Royal College of Surgeons of England and Department of Health (2011) Report on the peri-operative care of the the higher risk general surgical patient. http://www.rcseng.ac.uk/surgeons/surgical-standards/docs/The%20Higher%20Risk%20General%20Surgical%20Patient%20-%20Towards%20Improved%20Care%20for%20a%20Forgotten%20Group.pdf

  9. MEnSA study group, on behalf of Mersey Research Group for Surgery (2014) Risk stratification, management and outcomes in emergency general surgical patients in the UK. Eur J Trauma Emerg Surg 40:617–624. doi:10.1007/s00068-014-0399-2

    Article  Google Scholar 

  10. Fukuda N, Wada J, Niki M et al (2012) Factors predicting mortality in emergency abdominal surgery in the elderly. World J Emerg Surg 7:1. doi:10.1186/1749-7922-7-12

    Article  Google Scholar 

  11. Svenningsen P, Manoharan T, Foss NB et al (2014) Increased mortality in the elderly after emergency abdominal surgery. Dan Med J 61:A4876

    PubMed  Google Scholar 

  12. Arenal JJ, Bengoechea-Beeby M (2003) Mortality associated with emergency abdominal surgery in the elderly. Can J Surg 46:111–116

    PubMed  PubMed Central  Google Scholar 

  13. Park C-M et al (2014) Impact of Eastern Cooperative Oncology Group Performance Status on hospital mortality in critically ill patients. J Crit Care 29:409–413. doi:10.1016/j.jcrc.2014.01.016

    Article  PubMed  Google Scholar 

  14. Buccheri G, Ferrigno D, Tamburini M (1996) Karnofsky and ECOG performance status scoring in lung cancer: a prospective, longitudinal study of 536 patients from a single institution. Eur J Cancer 32:1135–1141. doi:10.1016/0959-8049(95)00664-8

    Article  Google Scholar 

  15. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213. doi:10.1097/01.sla.0000133083.54934.ae

    Article  PubMed  PubMed Central  Google Scholar 

  16. Clavien PA, Barkun J, de Oliveira ML et al (2009) The Clavien-Dindo Classification of surgical complications. Ann Surg 250:187–196. doi:10.1097/SLA.0b013e3181b13ca2

    Article  PubMed  Google Scholar 

  17. Yoon PD, Chalasani V, Woo HH (2013) Use of Clavien-Dindo Classification in reporting and grading complications after urological surgical procedures: analysis of 2010 to 2012. J Urol 190:1271–1274. doi:10.1016/j.juro.2013.04.025

    Article  PubMed  Google Scholar 

  18. Mentula PJ, Leppäniemi AK (2014) Applicability of the Clavien-Dindo Classification to emergency surgical procedures: a retrospective cohort study on 444 consecutive patients. Patient Saf Surg 8:31–37. doi:10.1186/1754-9493-8-31

    Article  PubMed  PubMed Central  Google Scholar 

  19. Neugebauer E, Sauerland S (2006) Guidelines for emergency laparoscopy. World J Emerg Surg 1:31

    Article  PubMed  PubMed Central  Google Scholar 

  20. Campanile FC, Pisano M, Coccolini F et al (2014) Acute cholecystitis: WSES position statement. World J Emerg Surg 9:1–6. doi:10.1186/1749-7922-9-58

    Article  Google Scholar 

  21. Di Saverio S, Bassi M, Smerieri N et al (2014) Diagnosis and treatment of perforated or bleeding peptic ulcers: 2013 WSES position paper. World J Emerg Surg 9:45–55. doi:10.1186/1749-7922-9-45

    Article  PubMed  PubMed Central  Google Scholar 

  22. Agresta F, Ansaloni L, Catena F et al (2014) Acute appendicitis: position paper, WSES, 2013. World J Emerg Surg 9:26–29. doi:10.1186/1749-7922-9-26

    Article  PubMed  PubMed Central  Google Scholar 

  23. Agresta F, Bedin N (2014) Laparoscopic approach in emergency surgery: which are the (our) new “evidence”. J Am Coll Surg 219:e99–e100. doi:10.1016/j.jamcollsurg.2014.07.650

    Article  Google Scholar 

  24. Agresta F, Ansaloni L, Baiocchi GL et al (2012) Laparoscopic approach to acute abdomen from the Consensus Development Conference of the Società Italiana di Chirurgia Endoscopica e nuove tecnologie (SICE), Associazione Chirurghi Ospedalieri Italiani (ACOI), Società Italiana di Chirurgia (SIC), Società Italiana di Chirurgia d’Urgenza e del Trauma (SICUT), Società Italiana di Chirurgia nell’Ospedalità Privata (SICOP), and the European Association for Endoscopic Surgery (EAES). Surg Endosc 26:2134–2164. doi:10.1007/s00464-012-2331-3

    Article  PubMed  Google Scholar 

  25. Letarte F, Hallet J, Drolet S et al (2015) Laparoscopic versus open colonic resection for complicated diverticular disease in the emergency setting: a safe choice? A retrospective comparative cohort study. Am J Surg 209:992–998. doi:10.1016/j.amjsurg.2014.07.017

    Article  PubMed  Google Scholar 

  26. Brooks-Brunn JA (1995) Postoperative atelectasis and pneumonia. Heart Lung 24:94–115

    Article  CAS  PubMed  Google Scholar 

  27. Smith PR, Baig MA, Brito V et al (2010) Postoperative pulmonary complications after laparotomy. Respiration 80:269–274. doi:10.1159/000253881

    Article  PubMed  Google Scholar 

  28. Lawrence VA, Hilsenbeck SG, Mulrow CD et al (1995) Incidence and hospital stay for cardiac and pulmonary complications after abdominal surgery. J Gen Intern Med 10:671–678

    Article  CAS  PubMed  Google Scholar 

  29. Futier E, Constantin J-M, Paugam-Burtz C et al (2013) A trial of intraoperative low-tidal-volume ventilation in abdominal surgery. N Engl J Med 369:428–437. doi:10.1056/NEJMoa1301082

    Article  CAS  PubMed  Google Scholar 

  30. Vester-Andersen M, Waldau T, Wetterslev J et al (2013) Effect of intermediate care on mortality following emergency abdominal surgery. The InCare trial: study protocol, rationale and feasibility of a randomised multicentre trial. Trials 14:37. doi:10.1186/1745-6215-14-37

    Article  PubMed  PubMed Central  Google Scholar 

  31. Vester-Andersen M, Lundstrom LH, Moller MH et al (2014) Mortality and postoperative care pathways after emergency gastrointestinal surgery in 2904 patients: a population-based cohort study. Br J Anaesth 112:860–870. doi:10.1093/bja/aet487

    Article  CAS  PubMed  Google Scholar 

  32. Awad S, Herrod PJJ, Palmer R et al (2012) One- and two-year outcomes and predictors of mortality following emergency laparotomy: a consecutive series from a United Kingdom Teaching Hospital. World J Surg 36:2060–2067. doi:10.1007/s00268-012-1614-0

    Article  PubMed  Google Scholar 

  33. Pasternak I, Dietrich M, Woodman R et al (2009) Use of severity classification systems in the surgical decision-making process in emergency laparotomy for perforated diverticulitis. Int J Color Dis 25:463–470. doi:10.1007/s00384-009-0852-6

    Article  Google Scholar 

  34. Matsuyama T, Iranami H, Fujii K et al (2013) Risk factors for postoperative mortality and morbidities in emergency surgeries. J Anesth 27:838–843. doi:10.1007/s00540-013-1639-z

    Article  PubMed  Google Scholar 

  35. Rubinfeld I, Thomas C, Berry S et al (2009) Octogenarian abdominal surgical emergencies: not so grim a problem with the acute care surgery model? J Trauma 67:983–989. doi:10.1097/TA.0b013e3181ad6690

    Article  PubMed  Google Scholar 

  36. Wong SS, Irwin MG (2016) Peri-operative cardiac protection for non-cardiac surgery. Anaesthesia 71:29–39. doi:10.1111/anae.13305

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

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

    Mai-Britt Tolstrup

  2. Department Surgery, Center for Surgical Science, Zealand University Hospital, Copenhagen University, Koege, Denmark

    Sara Kehlet Watt & Ismail Gögenur

Authors
  1. Mai-Britt Tolstrup
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  2. Sara Kehlet Watt
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  3. Ismail Gögenur
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Corresponding author

Correspondence to Mai-Britt Tolstrup.

Ethics declarations

This research was approved by the Danish Data Protection Agency; HEH-2013-034 I-Suite no: 02336. There was no requirement for approval by The National Committee on Health Research Ethics as the study was a non-interventional non-biomedical project. Mai-Britt Tolstrup MD, Sara Kehlet Watt MD, and Ismail Gögenur MD, DMSc declare that none of them has any conflict of interest. No external funding has been received to support this study.

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Tolstrup, MB., Watt, S.K. & Gögenur, I. Morbidity and mortality rates after emergency abdominal surgery: an analysis of 4346 patients scheduled for emergency laparotomy or laparoscopy. Langenbecks Arch Surg 402, 615–623 (2017). https://doi.org/10.1007/s00423-016-1493-1

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  • DOI: https://doi.org/10.1007/s00423-016-1493-1

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