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Mortality and postoperative care after emergency laparotomy.

06:00 EDT 11th September 2010 | BioPortfolio

Summary of "Mortality and postoperative care after emergency laparotomy."

BACKGROUND AND
OBJECTIVE:
Emergency laparotomy is a common high-risk surgical procedure, but with few outcome data and few data on postoperative care. We aimed to observe mortality within a mixed general surgical population and to explore the potential impact of postoperative care on mortality.
METHOD:
A prospective observational study of 124 patients undergoing emergency laparotomy. For all patients, overall mortality and 30-day survival were observed; the predicted death rate (PDR) using the P-POSSUM (Portsmouth predictor - Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity) score and the standardised mortality ratio (SMR) were calculated.
RESULTS:
Twenty-four patients died (19.4%); 21 in the first 30 days (16.9%). Twenty-six patients were over 80 years; 10 died (38%). PDR for all patients was 27.4%. The overall SMR was 0.71. Eighty-seven patients (70.2%) followed a postanaesthesia care unit (PACU)-ward pathway (observed mortality 13.6%; mean PDR 15.4%; SMR 0.82). Thirty (24.2%) patients followed an ICU-high dependency unit (HDU)-ward pathway (observed mortality 40.0%; mean PDR 57.2%; SMR 0.69). Six patients (4.8%) followed a PACU-HDU-ward pathway (observed mortality 0%, mean PDR 41.8%, SMR 0.0).
CONCLUSION:
Mortality after emergency laparotomy was high and very high in patients more than 80 years of age. The SMR was higher in the PACU-ward pathway compared to the ICU-HDU-ward pathway, suggesting room for improvement in the postoperative period.

Affiliation

From the University Hospital Wales, Cardiff (AC), Department of Anaesthesia and Intensive Care, Bristol Royal Infirmary, Bristol (HM, MJT) and Department of Anaesthesia and Intensive Care, Royal United Hospital, Combe Park, Bath (TMC, CJP), UK.

Journal Details

This article was published in the following journal.

Name: European journal of anaesthesiology
ISSN: 1365-2346
Pages:

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