Characterisation of older patients that require, but do not undergo, emergency laparotomy: a multicentre cohort study

IF 9.1 1区医学 Q1 ANESTHESIOLOGY

British journal of anaesthesia Pub Date : 2024-10-04 DOI:10.1016/j.bja.2024.07.009

Angeline Price , Elizabeth McLennan , Stephen R. Knight , Nicola Reeves , Susan Chandler , Jemma Boyle , Lyndsay Pearce , Susan J. Moug

{"title":"Characterisation of older patients that require, but do not undergo, emergency laparotomy: a multicentre cohort study","authors":"Angeline Price , Elizabeth McLennan , Stephen R. Knight , Nicola Reeves , Susan Chandler , Jemma Boyle , Lyndsay Pearce , Susan J. Moug","doi":"10.1016/j.bja.2024.07.009","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Older adults (≥65 yr) account for the majority of emergency laparotomies in the UK and are well characterised with reported outcomes. In contrast, there is limited knowledge on those patients that require emergency laparotomy but do not undergo surgery (NoLaps).</div></div><div><h3>Methods</h3><div>A multicentre cohort study (<em>n</em>=64 UK surgical centres) recruited 750 consecutive NoLap patients (February 15th - November 15th 2021, inclusive of a 90-day follow up period). Each patient was admitted to hospital with a surgical condition treatable by an emergency laparotomy (defined by The National Emergency Laparotomy Audit (NELA) criteria), but a decision was made not to undergo surgery (NoLap).</div></div><div><h3>Results</h3><div>NoLap patients were predominately female (452 patients, 60%), of advanced age (median age 83.0 yr, interquartile range 77.0–88.8), frail (523 patients, 70%), and had severe comorbidity (750 patients, 100%); 99% underwent CT scanning. The commonest diagnoses were perforation (26%), small bowel obstruction (17%), and ischaemic bowel (13%). The 90-day mortality was 79% and influencing factors were >80 yr, underweight BMI, elevated serum lactate or creatinine concentration. The majority of patients died in hospital (77%), with those with ischaemic bowel dying early. For the 21% of NoLap patients that survived to 90 days, 77% returned home with increased care requirements.</div></div><div><h3>Conclusions</h3><div>This study reports that the NoLap patient population present significant medical challenges because of their extreme levels of comorbidity, frailty, and physiology. Despite these complexities a fifth remained alive at 90 days. Further work is underway to explore this high-risk decision-making process.</div></div><div><h3>Clinical trial registration</h3><div>ISRCTN14556210.</div></div>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":null,"pages":null},"PeriodicalIF":9.1000,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"British journal of anaesthesia","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0007091224004203","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ANESTHESIOLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Background

Older adults (≥65 yr) account for the majority of emergency laparotomies in the UK and are well characterised with reported outcomes. In contrast, there is limited knowledge on those patients that require emergency laparotomy but do not undergo surgery (NoLaps).

Methods

A multicentre cohort study (n=64 UK surgical centres) recruited 750 consecutive NoLap patients (February 15th - November 15th 2021, inclusive of a 90-day follow up period). Each patient was admitted to hospital with a surgical condition treatable by an emergency laparotomy (defined by The National Emergency Laparotomy Audit (NELA) criteria), but a decision was made not to undergo surgery (NoLap).

Results

NoLap patients were predominately female (452 patients, 60%), of advanced age (median age 83.0 yr, interquartile range 77.0–88.8), frail (523 patients, 70%), and had severe comorbidity (750 patients, 100%); 99% underwent CT scanning. The commonest diagnoses were perforation (26%), small bowel obstruction (17%), and ischaemic bowel (13%). The 90-day mortality was 79% and influencing factors were >80 yr, underweight BMI, elevated serum lactate or creatinine concentration. The majority of patients died in hospital (77%), with those with ischaemic bowel dying early. For the 21% of NoLap patients that survived to 90 days, 77% returned home with increased care requirements.

Conclusions

This study reports that the NoLap patient population present significant medical challenges because of their extreme levels of comorbidity, frailty, and physiology. Despite these complexities a fifth remained alive at 90 days. Further work is underway to explore this high-risk decision-making process.

Clinical trial registration

ISRCTN14556210.

查看原文本刊更多论文

需要但未接受紧急开腹手术的老年患者的特征：一项多中心队列研究。

背景：在英国，老年人（≥65 岁）占急诊开腹手术的大多数，他们的特征和报告结果都很好。相比之下，人们对需要紧急开腹手术但未接受手术（NoLaps）的患者了解有限：一项多中心队列研究（n=64 个英国外科中心）招募了 750 名连续的 NoLap 患者（2021 年 2 月 15 日至 11 月 15 日，包括 90 天的随访期）。每位患者入院时均患有可通过急诊开腹手术治疗的外科疾病（根据国家急诊开腹手术审核（NELA）标准定义），但决定不接受手术治疗（NoLap）：NoLap患者主要为女性（452例，60%）、高龄（中位数年龄83.0岁，四分位数范围77.0-88.8岁）、体弱（523例，70%）、合并症严重（750例，100%）；99%的患者接受了CT扫描。最常见的诊断为穿孔（26%）、小肠梗阻（17%）和缺血性肠道（13%）。90 天死亡率为 79%，影响因素包括年龄大于 80 岁、体重不足、血清乳酸或肌酐浓度升高。大多数患者死于医院（77%），其中肠缺血患者死亡较早。在存活 90 天的 21% NoLap 患者中，77% 的患者回家后需要更多的护理：本研究报告指出，NoLap 患者因其极度的并发症、虚弱和生理状况而面临着巨大的医疗挑战。尽管情况复杂，但仍有五分之一的患者在 90 天后仍然存活。目前正在进一步研究这种高风险决策过程：临床试验注册：ISRCTN14556210。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

British journal of anaesthesia 医学-麻醉学

CiteScore

13.50

自引率

7.10%

发文量

488

审稿时长

27 days

期刊介绍： The British Journal of Anaesthesia (BJA) is a prestigious publication that covers a wide range of topics in anaesthesia, critical care medicine, pain medicine, and perioperative medicine. It aims to disseminate high-impact original research, spanning fundamental, translational, and clinical sciences, as well as clinical practice, technology, education, and training. Additionally, the journal features review articles, notable case reports, correspondence, and special articles that appeal to a broader audience. The BJA is proudly associated with The Royal College of Anaesthetists, The College of Anaesthesiologists of Ireland, and The Hong Kong College of Anaesthesiologists. This partnership provides members of these esteemed institutions with access to not only the BJA but also its sister publication, BJA Education. It is essential to note that both journals maintain their editorial independence. Overall, the BJA offers a diverse and comprehensive platform for anaesthetists, critical care physicians, pain specialists, and perioperative medicine practitioners to contribute and stay updated with the latest advancements in their respective fields.