AI Article Synopsis
- The study compares postoperative outcomes of emergency laparotomy patients before and after an emergency laparotomy pathway was implemented, addressing high morbidity and mortality rates associated with the procedure.
- The analysis involved a total of 888 patients, with a focus on those who underwent surgeries for acute abdominal issues, excluding trauma and vascular cases, and utilized propensity score matching to minimize confounding factors.
- Findings indicated that the emergency laparotomy pathway led to better outcomes, including higher assessments by geriatric medicine, lower rates of major morbidity and intra-abdominal complications, while length of stay and 30-day mortality rates remained similar between the two groups.
Article Abstract
Background: Emergency laparotomy is associated with high morbidity and significant global health burden. This study aims to compare postoperative outcomes of patients who underwent emergency laparotomy before and after implementation of a emergency laparotomy pathway.
Methods: This is a single-center study of all patients who presented with an acute abdomen and/or conditions requiring emergency laparotomy during pre-emergency laparotomy pathway (retrospective cohort from January 2016 to December 2018) and after the emergency laparotomy pathway (prospective cohort from January 2019 to December 2021). Patients who underwent emergency laparotomy for trauma or vascular surgery were excluded. A 1:1 propensity score matching was performed to address for confounding factors.
Results: There were 888 patients (emergency laparotomy pathway, n = 428, and pre-emergency laparotomy pathway, n = 460) in the unmatched cohort. The mean age was 63.0 ± 15.4 years, and 43.8% had predicted mortality >10% using Portsmouth-Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity. The most common indication for emergency laparotomy was intestinal obstruction (30.5%). Overall incidence rates of major morbidity and 30-day mortality were 16.2% and 3.5%, respectively. There were 736 patients (n = 368 patients per arm) after propensity score matching. Demographic characteristics were comparable after propensity score matching. The emergency laparotomy pathway was associated with more patients assessed by geriatric medicine (odds ratio = 15.22; P < .001), reduced major morbidity (odds ratio = 0.63; P = .024), reduced intra-abdominal collection (odds ratio = 0.39; P = .006), and need for unplanned radiological and/or surgical intervention after index emergency laparotomy (odds ratio = 0.63; P = .024). Length of stay and 30-day mortality were comparable between the emergency laparotomy pathway and pre-emergency laparotomy pathway in both the unmatched and propensity score matched cohort.
Conclusion: Sustained improved postoperative outcomes were achieved 3 years postimplementation of the emergency laparotomy pathway .
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| http://dx.doi.org/10.1016/j.surg.2024.04.016 | DOI Listing |
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