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The importance of discussing mortality risk prior to emergency laparotomy

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Abstract

Emergency laparotomies are often required for life-threatening conditions and consequently are associated with high mortality. This risk should be discussed with patients and ideally their next of kin (NOK). Failure to do so denies patients and their relatives the opportunity to prepare, breaches consent guidance, and may result in complaints and negligent claims. Patients who underwent an emergency laparotomy over 6 months were retrospectively studied. Mortality risk discussion with patients and their NOK as evidenced by documentation on consent forms or clinical notes was recorded. Factors influencing these discussions included patient’s age, American Society of Anaesthesiologists’ score, pre-operative diagnosis, Portsmouth Physiological and Operative Severity Score for the enumeration of Mortality and morbidity (P-POSSUM); seniority of consenting surgeon was also investigated. Seventy-six consecutive patients underwent an emergency laparotomy. Sixty-nine had capacity to give consent. Mortality risk was discussed with 24 (34.8%). These patients were older (median age 77.5 v 65.5 years; P < 0.05) and had a higher median P-POSSUM score (11.5% v 7%; P = 0.313) compared to patient with whom mortality risk was not discussed. Mortality risk was discussed with 14 (18.4%) NOK. This was not influenced by any factor studied. For patients requiring an emergency laparotomy, mortality risk was infrequently discussed with both patients and their NOK. These patients have a higher mortality risk than any other and this “failure to inform” has the potential for serious ramifications.

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Acknowledgements

The authors wish to thank the Royal Marsden Hospital Biomedical Research Council (BRC) for their support

Funding

All Authors have no source of funding.

Author information

Authors and Affiliations

  1. Department of Surgery, Watford General Hospital, Watford, UK

    Vernon Sivarajah & Vikas Pandey

  2. Department of Surgery and Cancer, Imperial College, London, UK

    Una Walsh, George Malietzis & Christos Kontovounisios

  3. Department of Colorectal Surgery, Royal Marsden Hospital, London, UK

    Christos Kontovounisios

  4. Department of Colorectal Surgery, Chelsea and Westminster NHS Foundation Trust, London, UK

    Christos Kontovounisios

  5. Department of Advanced Medical and Surgical Sciences, Universitá Della Campania “Luigi Vanvitelli”, Hospital Vall D’Hebron, Naples, Italy

    Gianluca Pellino

  6. Colorectal Surgery, Vall D’Hebron University Hospital, Barcelona, Spain

    Gianluca Pellino

Authors
  1. Vernon Sivarajah
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  2. Una Walsh
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  3. George Malietzis
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  4. Christos Kontovounisios
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  5. Vikas Pandey
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  6. Gianluca Pellino
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Contributions

VS: Colorectal Surgeon, Watford General Hospital. UW: Colorectal Surgery, Department of Surgery and Cancer, Imperial College London. GM: Colorectal Surgeon, Department of Surgery and Cancer, Imperial College London. CK: Consultant Colorectal Surgeon, Chelsea and Westminster Hospital, and Royal Marsden Hospital, London; Lecturer at Imperial College London. VP: Colorectal Surgeon, Watford General Hospital, London. GP: Consultant Colorectal Surgeon, Lecturer, Universitá della Campania Luigi Vanvitelli and Hospital Vall d’Hebron.

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Correspondence to Gianluca Pellino.

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The ethics committee of the institution where patients were enrolled approved the study.

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All patients gave written informed consent before undergoing any procedure. The study was in agreement with the Good Clinical Practice.

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Sivarajah, V., Walsh, U., Malietzis, G. et al. The importance of discussing mortality risk prior to emergency laparotomy. Updates Surg 72, 859–865 (2020). https://doi.org/10.1007/s13304-020-00756-z

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  • DOI: https://doi.org/10.1007/s13304-020-00756-z

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