Incidence and Risk Factors of Morbidity and Mortality in Emergency Laparotomy

Abstract

Background: The indications for emergency laparotomy are many, depending on different pathological causes, organs involved, and preoperative management. All these factors limit the time to optimize the comorbidities that may affect the outcome of surgery in terms of morbidity and mortality. Objectives: We aimed to detect the different predicting factors for morbidity and mortality after emergency laparotomies. Materials and methods: This prospective cohort study was conducted on 100 patients who were subjected to an emergency laparotomy. The demographic and clinical characteristics of the enrolled participants were registered. The study was carried out at Duhok Emergency Teaching Hospital from February 2022 to January 2023. Patients were followed for 30 days after surgery. Results: The mean age of the patients was 39.26 years ± 19.53, and males constituted 2/3 rd of the cases. The non-traumatic causes comprised the majority of cases. Patients with acute abdomen and intestinal obstruction comprised 74% of the cases. The commonest imaging finding was intra-abdominal collections (35%). The commonest operative finding was perforated gastric or duodenal ulcer (19%). Morbidity was reported in 69 patients. These included wound infection, anastomotic leakage, bleeding, deep venous thrombosis, and burst abdomen. There was a significant association (P-value < 0.05) between the morbidity and the age of the patient (OR: 1.5), body weight (OR: 1.9), associated comorbidities (OR: 1.2), operative time (OR: 1.76), performance of bowel anastomosis (OR: 5.5), and admission to the intensive care unit (ICU) (OR: 2.79). Mortality was reported in 9 patients, and there was a significant association (P-value < 0.05) with anastomotic leakage (OR: 4.27), need for anti-coagulation (OR: 23.65), and admission to the ICU (OR: 16.36). Conclusion: Emergency laparotomy is associated with high incidences of morbidity and mortality. The patient’s age, body weight, associated comorbidities, operative time, performance of bowel anastomosis, and admission to the ICU might be risk factors for morbidity. High mortality might be due to anastomotic leakage, the requirement of anticoagulation, and ICU admission.