Post-operative Complications Following Emergency Laparotomy are Common and Associated with Increased Late Mortality – a Retrospective Multi-centre Study.

Abstract BackgroundThe first National Emergency Laparotomy Audit (NELA) highlighted that morbidity and mortality from emergency surgery remains elevated especially in high-risk patients defined as a P-POSSUM mortality ≥ 5% and ASA ≥ 3. The incidence of postoperative pulmonary complications (PPCs) are thought to be high following emergency laparotomy but no recent studies have evaluated the incidence or consequences of PPC following emergency laparotomy in the UK.MethodsA retrospective cohort study was conducted at University Hospital Birmingham and Heartlands Hospital, Birmingham, to investigate the incidence of PPCs following emergency laparotomy. The NELA databases from the two Trusts were used to identify patients. Patients were retrospectively screened for the development of PPCs using the validated Melbourne Group Scale. Data was analysed using Chi-squared test for categorical data and continuous data displayed as medians with statistical analysis from a Mann–Whitney U test. Results A total of 362 correctly coded patients were identified. High-risk patients accounted for 62% (226) of the cohort. These patients were older (p < 0.001) and had higher baseline lactate (p = 0.04) and creatinine levels (p = 0.003). Median P-POSSUM mortality was 10.6% (5.6–31.4%) with 76.4% of patients having an ASA ≥ 3. These patients had an increased length of stay (p < 0.001) and accounted for nearly all the deaths (42 vs. 2; p < 0.001). The incidence of PPCs was 37%, again the incidence was greater in the high-risk group (37% vs. 6% p < 0.001). Development of a PPC was associated with an increased length of stay (17 d vs. 9 d; p < 0.001) as well as a 90, 180 and 360 day mortality.DiscussionThis study demonstrates that the sub-group of patients deemed ‘high-risk’ are at greatest risk of developing a PPC and consequently have an increased length of stay and an increased 90, 180 and 360 day mortality. This allowed us to identify a group of patients at high risk of PPC who we can target with potential novel therapies such as high-flow nasal cannulae oxygen in clinical trials to reduce mortality and morbidity.