Risk assessment in emergency laparotomy for outcome prediction in patients presenting to the emergency department

Abstract

Background: Despite a larger percentage of high-risk patients presenting for emergency surgery, the perioperative mortality has decreased significantly over the last half-century. By identifying high-risk patients in the preoperative phase and planning their perioperative management, morbidity and mortality can be reduced. This risk increases if the surgery is performed as an emergency. The main aim of this study is to evaluate risk factors that may be associated with higher postoperative mortality in patients undergoing emergency laparotomy, which can help in better management to decrease postoperative mortality. Patients and Methods: Patients who presented to Kasr Alainy Hospital of Cairo University, Emergency Department who underwent emergency laparotomy were evaluated for risk factors, which include age, sex, type of surgery, the time interval between onset of symptoms and surgical intervention, presence of peritonitis preoperatively, and previous laparotomy. Postoperatively, patients were followed up for occurrence of 10 days postoperative mortality, hospital readmission within 2 weeks after hospital discharge, and length of postoperative hospital stay. Results: The mean age of patients of emergency laparotomy was 42 years while the male : female ratio was 1.14 : 1. Indication of surgery showed a statistically significant difference in mortality with the highest incidence in patients with intestinal ischemia. The longest hospital stay was found in patients with blunt abdominal trauma. Conclusion: The type of surgery, according to the pathology of the target organ, can affect the 10 days postoperative mortality, which is highest in patients with intestinal ischemia.