Introduction There is increasing interest in assessing outcomes from emergency laparotomy in the UK, and implementing care bundles to improve them. This follows on from work from the National Emergency Laparotomy Network suggesting that laparotomy mortality rates are at a level that would be ‘unthinkable’ from elective surgery (average 14.9% mortality). It noted variability in presence of consultant surgeons and anaesthetists at the surgery and related this to possible variations in mortality. In the knowledge that consultant presence at laparotomy is extremely high at our busy District General Hospital, research was carried out into the factors influencing the survival of the emergency laparotomy patients.
Method A prospective database was created of 144 consecutive laparotomy patients, using local hospital and NELA data. The following factors were ascertained: grade of surgeon and anaesthetist, deprivation score, day of week of surgery, time of day of surgery, ASA grade, postoperative P-POSSUM predicted mortality (combining operative severity score and preoperative physiology), length of stay, 30-day mortality. Survival was ascertained using Kaplan-Meier analysis, with univariate analysis by log-rank test and then multivariate analysis performed using Cox Proportional Hazards Analysis.
Results 100% of patients were operated on by consultant surgeons and 95% had a consultant anaesthetist presence. The 30-day mortality rate seen overall was 17.4%. It was notable that the mean P-POSSUM score for the patients was 17.2%. 50% were aged over 65. Of note even on univariate analysis, time of day of operation and weekday versus weekend were not significant predictors of mortality. On multivariate analysis, P-POSSUM score, ASA grade and age remained independent predictors of emergency laparotomy mortality.
Conclusion Even in a series of patients operated on exclusively by consultants, mortality is close to the national average. It is likely that strong influences on this are the severity of patient physiology and severity of operation, seen in the striking similarity of mean P-POSSUM and observed mortality in these patients, and its independence on multivariate analysis. As expected, age is also an independent factor. Further work will be carried out to see if any remediable factors could be contributing.
Disclosure of interest None Declared.
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