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Current UK practice in emergency laparotomy
E Barrow1, I D Anderson, S Varley
1UK Emergency Laparotomy Network.
Insights
Emergency laparotomy in the UK has a high 30-day mortality rate of 14.8%. Factors like procedure urgency, small bowel resection, and abdominal sepsis significantly increase patient risk.
Area of Science:
- Surgical outcomes research
- Patient safety in emergency surgery
Background:
- Emergency laparotomy is a frequent surgical procedure in the UK, with 30,000-50,000 cases annually.
- This study investigates the spectrum of emergency laparotomies and their impact on mortality.
Purpose of the Study:
- To analyze the current spectrum of emergency laparotomies in the UK.
- To determine the influence of surgical procedure, pathology, and surgeon subspecialty on 30-day mortality.
Main Methods:
- Anonymized data from consecutive emergency laparotomy patients were collected over three months.
- The primary outcome was unadjusted 30-day mortality; appendicectomy and cholecystectomy were excluded.
Main Results:
- Overall 30-day mortality was 14.8% across 1,708 patients from 35 hospitals.
- Immediate or urgent laparotomies accounted for 86.5% of cases, with mortality increasing by urgency.
- Small bowel resection (21.1% mortality) and abdominal sepsis (17.5% mortality) were associated with higher mortality rates.
Conclusions:
- Emergency laparotomy in the UK has a high mortality rate by modern standards.
- Most pathologies and procedures are high-risk, necessitating consultant involvement and critical care.
- Further research is needed on the impact of surgical subspecialty in emergency colonic surgery outcomes.
Introduction:
Emergency laparotomy is a common procedure, with 30,000-50,000 performed annually in the UK. This large scale study reports the current spectrum of emergency laparotomies, and the influence of the surgical procedure, underlying pathology and subspecialty of the operating surgeon on mortality.
Methods:
Anonymised data on consecutive patients undergoing an emergency laparotomy were submitted for a three-month period. The primary outcome measure was unadjusted 30-day mortality. Appendicectomy and cholecystectomy were among the procedures excluded.
Results:
Data from 1,708 patients from 35 National Health Service hospitals were analysed. The overall 30-day mortality rate was 14.8%. 'True' emergency laparotomies (ie those classified by the National Confidential Enquiry into Patient Outcome and Death as immediate or urgent) comprised 86.5% of cases. The mortality rate rose from 8.0% among expedited cases to 14.3% among urgent cases and to 25.7% among laparotomies termed immediate. Among the most common index procedures, small bowel resection exhibited the highest 30-day mortality rate of 21.1%. The presence of abdominal sepsis was associated with raised 30-day mortality (17.5% in the presence of sepsis vs 12.6%, p=0.027). Colorectal procedures comprised 44.3% and within this group, data suggest that mortality from laparotomy may be influenced by surgical subspecialisation.
Conclusions:
This report of a large number of patients undergoing emergency laparotomy in the UK confirms a remarkably high mortality by modern standards across the range. Very few pathologies or procedures can be considered anything other than high risk. The need for routine consultant involvement and critical care is evident, and the case distribution helps define the surgical skill set needed for a modern emergency laparotomy service. Preliminary data relating outcomes from emergency colonic surgery to surgical subspecialty require urgent further study.
