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Gastrointestinal Discontinuity After Emergency Laparotomy
Peter Liao1, Kyle Hoffman1, Andrew Broussard1
1Department of Surgery, Ochsner Clinic Foundation, New Orleans, LA, USA.
Insights
Predicting survival in patients with gastrointestinal discontinuity (GID) after emergency bowel resection is crucial. High lactate levels and vasopressor use are key indicators of futile situations, aiding end-of-life decisions.
Area of Science:
- Surgery
- Critical Care Medicine
- Gastroenterology
Background:
- Patients undergoing emergency bowel resection may experience temporary gastrointestinal discontinuity (GID).
- Identifying patients with futile prognoses is essential for guiding clinical decisions and end-of-life care.
Purpose of the Study:
- To determine predictors of futility in patients initially left in GID after emergency bowel resection.
- To identify factors associated with mortality versus survival in this patient cohort.
Main Methods:
- Retrospective study of 120 patients with GID after emergency bowel resection.
- Patients categorized into three groups: never restored continuity and died, restored continuity and died, and restored continuity and survived.
- Multivariate logistic regression analysis to identify significant predictors of survival.
Main Results:
- Lactate levels (P = .002) and vasopressor use (P = .014) were significant predictors of survival.
- Out of 120 patients, 58 died and 62 survived.
- 31 patients never restored continuity and died, 27 restored continuity and died, and 62 restored continuity and survived.
Conclusions:
- Elevated lactate and the need for vasopressors are critical indicators for predicting futile situations in GID patients.
- These findings can inform end-of-life discussions and decision-making for patients with poor prognoses.
Abstract:
During laparotomy, patients requiring intestinal resection may be temporarily left in gastrointestinal discontinuity (GID). We performed this study to determine predictors of futility for patients initially left in GID after emergency bowel resection. We divided the patients into 3 groups: never restored continuity and died (group 1), restored continuity and died (group 2), and restored continuity and survived (group 3). We compared the 3 groups for differences in demographics, acuity at presentation, hospital course, laboratory data, comorbidities, and outcomes. From a total of 120 patients, 58 patients died and 62 survived. We identified 31 patients in group 1, 27 patients in group 2, and 62 patients in group 3. On multivariate logistic regression, only lactate (P = .002) and use of vasopressors (P = .014) remained significant to predict survival. The results of this study can be used to identify futile situations which can direct end-of-life decisions.
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