Nontraumatic emergency laparotomy : surgical principles similar to trauma need to be adopted?
Singh-Ranger, Deepak Leung, Edmund Lau-Robinson, Mei-Ling Ramcharan, Sean Francombe, James
Singh-Ranger, Deepak
Leung, Edmund
Lau-Robinson, Mei-Ling
Ramcharan, Sean
Francombe, James
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South Warwickshire University NHS Foundation Trust
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Publication date
2017-11
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Abstract
Objectives: In 2011, the Royal College of Surgeons published Emergency Surgery: Standards for Unscheduled Care in response to variable clinical outcomes for emergency surgery. The purpose of this study was to examine whether different treatment modalities would alter survival.
Methods: All patients who underwent emergency laparotomy between April 2011 and December 2012 at Warwick Hospital (Warwick, UK) were included retrospectively. Information relating to their demographics; preoperative score; primary pathology; timing of surgery; intraoperative details; and postoperative outcome, including 30-day mortality, were collated for statistical analysis.
Results: In total, 91 patients underwent 97 operations. The median age was 64 years (range 50-90, male:female 1:2). Sixty-five percent of cases were obstruction and perforation, and 66% of all operations were performed during office hours. The unadjusted 30-day mortality was 15.4%. Compared with nonsurvivors, survivors had a significantly higher Portsmouth-Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity score (P < 0.001), prolonged duration of hypotension and use of inotropes (P = 0.013), higher volume of colloid use (P = 0.04), and lower core body temperature (P < 0.05). Grades of surgeons did not influence mortality.
Conclusions: The 30-day mortality rate is comparable to the national standard. Further studies are warranted to determine whether trauma management modalities may be adopted to target high-risk patients who exhibit the lethal triad of hypotension, coagulopathy, and hypothermia.
Citation
Singh-Ranger D, Leung E, Lau-Robinson ML, Ramcharan S, Francombe J. Nontraumatic Emergency Laparotomy: Surgical Principles Similar to Trauma Need to Be Adopted? South Med J. 2017 Nov;110(11):688-693. doi: 10.14423/SMJ.0000000000000721.
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Article