Mostafa Khalil, Tarek Khalil, Abigail Johnston, Ibrahim Ibrahim, Darren J Porter* and Michael S J Wilson
Department of General and Emergency Surgery, Ninewells Hospital and Medical School, Dundee, Scotland, UKFulltext PDF
Objectives: Emergency laparotomy remains one of the most common general surgical procedures
in the UK. It is associated with an increased risk of mortality. This paper examines the relationship
between mortality following an emergency laparotomy and admission to the correct specialty.
Method: This was a retrospective cohort study. The emergency theatre logbooks of December
2014 to January 2019 were reviewed to identify those patients that had undergone an emergency
laparotomy. Dates of (admission, operation, discharge and death) were collected, as well as
admitting specialty. Exclusion criteria: Gynecological, vascular conditions such as AAA, as well as
direct ED to theatre cases. The cohort of patients was then divided into groups as per admitting
specialty (Medical and Surgical wards) and analyzed.
Results: 578 laparotomies were included in the study. Mean age was 63 for both surgical and medical
admissions. Overall mortality at 30-day, 90-day, 1 and 3-year were 13.1%, 16.9%, 23.5% and 32.4%
respectively. General surgical mortality at 30-day, 90-day, 1 and 3-year were 11.6%, 15.2%, 21.2%
and 29.6% respectively. Medical mortality at 30-day, 90-day, 1 and 3-year were 19.8%, 23.4%, 33.3%
and 44.1% respectively. P-values were <0.021, <0.037, <0.007 and <0.003 for 30-day, 90-day, 1-year
and 3-year mortality respectively.
Conclusion: Mortality is higher in patients that need a laparotomy when admitted under medical
specialties. Reasons are likely multifactorial. However, we conclude that timely recognition for a
need for laparotomy by a general surgeon is likely to reduce mortality. We recommend that all
attempts be made to appropriately admit patients with abdominal pain to surgery.
Khalil M, Khalil T, Johnston A, Ibrahim I, Porter DJ, Wilson MSJ. The Relationship between Patient Mortality Post Emergency Laparotomy and Admitting Specialty. World J Surg Surgical Res. 2020; 3: 1233..