Patient Experience of Emergency Laparotomy: A Mixed Methods Study (The PEEL-2 Study)

Emergency laparotomy (EmLap) is a high-risk surgery for acute abdominal conditions. This study uses a retrospective mixed-methods approach to explore quality of life and patient-reported outcomes and experiences (PROMs and PREMs) among EmLap survivors.

Patients who underwent EmLap from 2016-2019 at a tertiary hospital were surveyed, with demographic and clinical data collected from institutional National Emergency Laparotomy Audit (NELA) databases. Outcomes included QoL (EQ-5D-5L), employment, sexual function, incisional hernias, peri-operative anxiety, body image, and overall patient experience. The themes explored in the questionnaire were developed based on findings from previous studies of EmLap survivorship. Thematic analysis was conducted for qualitative responses, alongside statistical analysis for quantitative data.

A total of 725 eligible patients were identified, and 310 responses were returned (42.8% response rate). Mean length of follow up was 33 months (range 6-54 months). Regression analysis confirmed QoL was associated with higher socioeconomic status (coefficient 0.047, p < 0.001), reduced BMI (coefficient -0.009, p < 0.05) and reduced ASA (coefficient -0.070, p < 0.05). Nearly half of respondents were retired at the time of surgery; among those who were employed, 40.5% experienced changes in employment which included earlier retirement. Recovery of sexual function was delayed, with 11.3% of patients reporting they had not resumed sexual activity post-surgery. Incisional hernia was reported by 38.9% of respondents, and 34.0% expressed dissatisfaction with body image. Free-text responses revealed unmet needs for mental health support (22.6%), dietary guidance (10.3%), and physiotherapy (15.8%).

These findings highlight the physical, psychological, and socioeconomic burden faced by patients after EmLap, and support the need for tailored post-operative support systems to be integrated into post-operative care.