Mortality and postoperative care after emergency laparotomy.
Summary of "Mortality and postoperative care after emergency laparotomy."
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.
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.
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).
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.
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.
This article was published in the following journal.
Name: European journal of anaesthesiology
- PubMed Source: http://www.ncbi.nlm.nih.gov/pubmed/20829702
- DOI: http://dx.doi.org/10.1097/EJA.0b013e32833f5389
The aim of this study was to explore the risk factors and how to avoid re-laparotomy after caesarean delivery and to present the experience of a university tertiary care referral hospital. The study c...
Emergency surgery or transarterial embolization (TAE) are options for the treatment of recurrent or refractory nonvariceal upper gastrointestinal bleeding. Surgery has the disadvantage of high rates o...
With the increasing aging population, the number of very elderly patients (age ≥80 years) undergoing emergency operations is increasing. Evaluating patient-specific risk factors for postoperative mo...
Changes in pulmonary dynamics following laparotomy are well documented. Deep breathing exercises, with or without incentive spirometry, may help counteract postoperative decreased vital capacity; howe...
The aim of this study is to investigate postoperative complications, mortality rates, and to determine the factors affecting mortality on the patients receiving warfarin therapy preoperatively, as wel...
To test the hypotheses that hypertensive emergency was associated with non-compliance with antihypertensive medication, low level of contact with the medical care system, and alcohol abuse...
Community acquired pneumonia (CAP) is associated with a high in-hospital mortality. Standardization of diagnostics and adherence to sepsis bundles in the emergency department (ED) are asso...
Decompressive laparotomy with temporary abdominal closure, will decrease of overall mortality and major morbidity in patients with abdominal compartment syndrome during acute pancreatitis ...
Since the report "To Err is Human" by the Institute of Medicine (IOM) in 1999, attention was brought to the general public that adverse events in medicine are common and are one of the lea...
The research hypothesis for this study is to possibly reduce the incidence of incisional hernia 2 years postoperatively after midline laparotomy for treatment of aortic aneurysm from 25% t...
Medical and Biotech [MESH] Definitions
Paramedical personnel trained to provide basic emergency care and life support under the supervision of physicians and/or nurses. These services may be carried out at the site of the emergency, in the ambulance, or in a health care institution.
An interval of care by a health care facility or provider for a specific medical problem or condition. It may be continuous or it may consist of a series of intervals marked by one or more brief separations from care, and can also identify the sequence of care (e.g., emergency, inpatient, outpatient), thus serving as one measure of health care provided.
Services specifically designed, staffed, and equipped for the emergency care of patients.
The specialty or practice of nursing in the care of patients admitted to the emergency department.
Hospital department responsible for the administration and provision of immediate medical or surgical care to the emergency patient.