Retrospective cohort study of perioperative factors and outcomes in emergency laparotomy in Palestine

Few studies have evaluated outcomes following emergency laparotomy in Palestinian practice. In this retrospective cohort study, we assessed the association between perioperative factors and the primary outcome of in-hospital mortality. Secondary outcomes included the evaluation of perioperative risk factors for postoperative complications, overall complication and mortality rates, length of hospital stay, intensive care unit (ICU) admission rates, and the proportion of patients requiring postoperative intubation.

We conducted a retrospective cohort study of 385 consecutive adult patients who underwent emergency laparotomy within 24 h of admission a major tertiary care center in the West Bank over a 5-year period (January 1, 2018 and December 31, 2022). Chi-square or Fisher's exact test, Mann-Whitney U test, regression, and survival analysis were conducted to determine associations between perioperative factors and patient outcomes.

In-hospital mortality was significantly predicted by female sex (AOR = 4.6; 95% CI: 1.7-12.2; p = 0.002), smoking (AOR = 5.2; 95% CI: 1.3-20.3; p = 0.017), and obesity (AOR = 5.6; 95% CI: 1.2-25.7; p = 0.028). Additionally, American Society of Anesthesiologists class 3 or higher (AOR = 5.1; 95% CI: 1.9-13.2; p = 0.001), mechanical intubation (AOR = 7.8; 95% CI: 2.0-30.2; p = 0.003), vasopressor use (AOR = 4.6; 95% CI: 1.8-11.9; p = 0.002), and postoperative complications (AOR = 33.1; 95% CI: 7.0-155.7; p < 0.001) were strong predictors of in-hospital mortality. The hazard ratio for mortality associated with postoperative complications was 5.3 (95% CI: 3.2-8.9; log-rank p < 0.001). Patients experiencing complications had longer ICU stays and prolonged intubation durations. In addition, postoperative complications were independently associated with in-hospital mortality (AOR = 28.7; 95% CI: 6.7-123.1; p < 0.001).

Findings indicated that postoperative complications and mortality were significantly associated with modifiable perioperative risk factors. Strategies such as smoking cessation programs, optimized management of comorbidities, and healthcare system improvements may help mitigate postoperative complications and reduce mortality among emergency laparotomy patients in Palestine.