669 Chronological Distribution and Causes of Mortality Following Emergency Laparotomy – an 8 Year Study
E O'Connell, R Kyriakides, O Rutka, N Misra- Surgery
Abstract
Introduction
Emergency laparotomies have variable level of mortality and morbidity worldwide. Studying the causes and times of mortality, could enable better patient care and improve future outcomes. We investigated the mortality data in laparotomy patients, to investigate for trends in mortality and other patient and process characteristics.
Method
Data for all emergency laparotomies undertaken between 2014 to 2022 were collected prospectively and retrospectively analysed. The primary outcome was inpatient mortality. Demographics, clinical management, and outcome data was analysed using SPSS.
Results
1410 laparotomies performed, with an overall crude mortality rate of 11.9%. The P-POSSUM mortality and morbidity scores ranged from 2-99 (mean 42.4) and 40.1-100 (mean 86.6) respectively. The time from operation to death ranged from 24 hours to 123 days (mean = day 11.75), with a uni-modal distribution. In the first 48 hours post-operatively 28.57% (N = 56 patients) died, with a mean age of 70.6 and a mean P-POSSUM of 48.1 (SD 30.6). Bowel perforation (N = 19 patients) and bowel ischaemia (N = 13 patients) where the most common intra-operative finding. The patients that died after 48 hours (N = 116 patients) had a mean age of 73.5 (SD 12.4) and a mean P-POSSUM of 39.6 (SD 29.9, P 0.92), compared to those that survived (N = 1241) with a mean age of 61.4 (SD 16.4) and a mean P-POSSUM of 15.6 (P>0.01).
Conclusions
Emergency laparotomy has a high level of mortality and morbidity, with the first 48 hours carrying the highest risk, particularly in those with bowel perforation or ischaemia.