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175 Emergency Laparotomy Audit in Cancer:peri-operative predictors of mortality andmorbidity in patients who underwentemergency laparotomy in cancer.

In Anaesthesia.
By: Solanki S.
Contributor(s): P.NB | Agarwal V.
Material type: materialTypeLabelArticlePublisher: 2018Description: .Subject(s): Laparotomy | Chemotherapy | Radiotherapy In: Anaesthesia Vol.73., no.S4., p.99Summary: MethodsEmergency laparotomy is a common intra-abdominal procedure, where out-comes are generally recognised to be poor. Variation in surgical pathology witha limited time period in which to optimise comorbidities contribute to postoper-ative morbidity and mortality [1]. The aim of this retrospective analysis was toestimate peri-operative factors and outcome in terms of morbidity and mortalityin patients with cancer undergoing emergency laparotomy in a tertiary care can-cer institute. The study commenced after approval from the institutional ethicscommittee, with a waiver of consent. Pre-operative details included demographicprofile and ASA status, diagnosis, indication for surgery, pre-operativechemotherapy and radiotherapy details and pre-operative laboratory investiga-tions. Intra-operative details such as anaesthetic technique, blood loss, peri-operativefluid and blood and its components, duration of surgery, intra-opera-tive complications, use of vasopressors and shifting condition of the patient werecollected. Postoperative details such as length of intensive care stay and postop-erative complications, postoperative mechanical ventilation and vasopressor use,hospital stay, morbidity and 30-day mortality were collected.ResultsEmergency laparotomy was performed on 431 patients over an observation per-iod of 2 years. The median age of the patients was 68 years. The unadjusted 30-day mortality was 14.9% for all patients and 20.4% in patients aged≥65 years.Patients who followed the intensive care unit–ward pathway had a mortality of31.4% vs. a mortality of 4% in recovery room–ward pathway. Median length ofstay for all patients was 14.5 days, and among survivors and non-survivors it was8 and 13 days, respectively. Pre-operative albumin levels<2.1 mg.dl–1had asignificant mortality and morbidity.DiscussionWe found a high mortality after acute admission and emergency laparotomy.Age and ASA status are well-recognised risk factors for postoperative mortality.Outcome in patients with perforated viscus and bowel gangrene are very poor.Pre-operative albumin has a significant impact on both morbidity and mortality.Data from across the world have consistently shown that about 15% of patientsdie within a month of emergency bowel surgery [2, 3]. This is 5–10 times greaterthan for‘high-risk’elective surgery such as cardiac, vascular and cancer surgery,including elective bowel surgery.References1. The Second Patient Report of the National Emergency Laparotomy Audit(NELA) December 2014 to November 2015.2. Saunders DI, Murray D, Pichel AC, Varley S, Peden CJ. Variations in mortalityafter emergency laparotomy.BJA2012;109: 368–75.3. Vester-Andersen M, Lundstrøm LH, Møller MH, Waldau T, Rosenberg J, MøllerAM. Mortality and postoperative care pathways after emergencygastrointestinal surgery in 2904 patients.BJA2014;112: 860–70.ApprovalsRECApproval obtainedR&D departmentApproval obtainedAudit departmentApproval obtainedCaldicott GuardianApproval obtainedConsentNone
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Articles Articles Tata Memorial Hospital
Available AR19215

Abstract presented in the Annual Congress 2018, 26‐28 September 2018, Dublin, Ireland

MethodsEmergency laparotomy is a common intra-abdominal procedure, where out-comes are generally recognised to be poor. Variation in surgical pathology witha limited time period in which to optimise comorbidities contribute to postoper-ative morbidity and mortality [1]. The aim of this retrospective analysis was toestimate peri-operative factors and outcome in terms of morbidity and mortalityin patients with cancer undergoing emergency laparotomy in a tertiary care can-cer institute. The study commenced after approval from the institutional ethicscommittee, with a waiver of consent. Pre-operative details included demographicprofile and ASA status, diagnosis, indication for surgery, pre-operativechemotherapy and radiotherapy details and pre-operative laboratory investiga-tions. Intra-operative details such as anaesthetic technique, blood loss, peri-operativefluid and blood and its components, duration of surgery, intra-opera-tive complications, use of vasopressors and shifting condition of the patient werecollected. Postoperative details such as length of intensive care stay and postop-erative complications, postoperative mechanical ventilation and vasopressor use,hospital stay, morbidity and 30-day mortality were collected.ResultsEmergency laparotomy was performed on 431 patients over an observation per-iod of 2 years. The median age of the patients was 68 years. The unadjusted 30-day mortality was 14.9% for all patients and 20.4% in patients aged≥65 years.Patients who followed the intensive care unit–ward pathway had a mortality of31.4% vs. a mortality of 4% in recovery room–ward pathway. Median length ofstay for all patients was 14.5 days, and among survivors and non-survivors it was8 and 13 days, respectively. Pre-operative albumin levels<2.1 mg.dl–1had asignificant mortality and morbidity.DiscussionWe found a high mortality after acute admission and emergency laparotomy.Age and ASA status are well-recognised risk factors for postoperative mortality.Outcome in patients with perforated viscus and bowel gangrene are very poor.Pre-operative albumin has a significant impact on both morbidity and mortality.Data from across the world have consistently shown that about 15% of patientsdie within a month of emergency bowel surgery [2, 3]. This is 5–10 times greaterthan for‘high-risk’elective surgery such as cardiac, vascular and cancer surgery,including elective bowel surgery.References1. The Second Patient Report of the National Emergency Laparotomy Audit(NELA) December 2014 to November 2015.2. Saunders DI, Murray D, Pichel AC, Varley S, Peden CJ. Variations in mortalityafter emergency laparotomy.BJA2012;109: 368–75.3. Vester-Andersen M, Lundstrøm LH, Møller MH, Waldau T, Rosenberg J, MøllerAM. Mortality and postoperative care pathways after emergencygastrointestinal surgery in 2904 patients.BJA2014;112: 860–70.ApprovalsRECApproval obtainedR&D departmentApproval obtainedAudit departmentApproval obtainedCaldicott GuardianApproval obtainedConsentNone

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