Getting back 'home' after emergency laparotomy: how many never make it?

Area of Science:

• Surgery
• Geriatric Medicine
• Public Health

Background:

• Emergency laparotomy (EL) is a critical surgical procedure performed annually on approximately 15,500 patients in Australia.
• A significant concern following EL is the potential for previously independent patients to require long-term dependent care.
• This study investigates the proportion of patients who do not return to their pre-admission residence post-EL, serving as a proxy for dependent care.

Purpose of the Study:

• To determine the rate at which patients return to their pre-admission residence after emergency laparotomy.
• To assess the long-term functional outcomes and care needs of patients following emergency laparotomy.
• To provide data to inform shared decision-making for emergency laparotomy patients.

Main Methods:

• A retrospective study collected data from 782 adult patients undergoing emergency laparotomy across four Australian hospitals over two years.
• Data included pre-hospital residence, discharge destination, mortality, and residence status at 90 and 365 days post-procedure.
• Key outcome was the proportion of patients returning to their pre-admission residence.

Main Results:

• Of 782 patients, 95.5% lived at home pre-admission. Inpatient mortality was 7.0%.
• At 90 days, 87% of survivors had returned home, including all patients under 70.
• By 365 days, 16.8% overall mortality, with only 1.5% of patients (all >70 years) not returning to their pre-admission residence.

Conclusions:

• The vast majority of emergency laparotomy survivors return to their pre-admission residence.
• Long-term dependent care is required by only a small fraction of previously independent patients post-EL.
• Findings support shared decision-making regarding the risks and outcomes of emergency laparotomy.