Getting back 'home' after emergency laparotomy: how many never make it?
decision making
general surgery
laparotomy
mortality
quality of life
Journal
ANZ journal of surgery
ISSN: 1445-2197
Titre abrégé: ANZ J Surg
Pays: Australia
ID NLM: 101086634
Informations de publication
Date de publication:
10 2023
10 2023
Historique:
revised:
19
07
2023
received:
18
05
2023
accepted:
27
08
2023
medline:
23
10
2023
pubmed:
7
9
2023
entrez:
7
9
2023
Statut:
ppublish
Résumé
Emergency laparotomy (EL) is performed on about 15 500 patients in Australia each year. Aside from mortality there is significant concern about the possibility that previously independent patients discharged after EL will become reliant on long-term dependent care. This study aimed to establish the proportion of patients not returning to their pre-admission residence, a proxy for dependent care, following EL. Data were collected on all adult patients who underwent EL across four Australian hospitals over 2 years. A total of 113 data points were collected including pre-hospital residence, discharge destination, mortality and place of residence at 90 and 365 days. A total of 782 patients underwent EL, the mean age was 64 years. Pre-admission, 95.5% of patients were living in their own home. Inpatient mortality was 7.0% and at discharge 72.4% of patients returned directly back to their pre-hospital residence. At 90 days, mortality was 10.5%, and 87% of patients had returned to their pre-hospital residence, including all patients under 70 years of age. By 365 days, overall mortality was 16.8%, and only 1.5% of patients (all aged >70 years) had not returned to their pre-hospital residence. Patients who survive 90 and 365 days following EL nearly all return to their pre-hospital residence, with only a very small proportion of previously independent patients entering dependent care. This should help inform shared decision-making regarding emergency laparotomy in the acute setting.
Sections du résumé
BACKGROUND
Emergency laparotomy (EL) is performed on about 15 500 patients in Australia each year. Aside from mortality there is significant concern about the possibility that previously independent patients discharged after EL will become reliant on long-term dependent care. This study aimed to establish the proportion of patients not returning to their pre-admission residence, a proxy for dependent care, following EL.
METHODS
Data were collected on all adult patients who underwent EL across four Australian hospitals over 2 years. A total of 113 data points were collected including pre-hospital residence, discharge destination, mortality and place of residence at 90 and 365 days.
RESULTS
A total of 782 patients underwent EL, the mean age was 64 years. Pre-admission, 95.5% of patients were living in their own home. Inpatient mortality was 7.0% and at discharge 72.4% of patients returned directly back to their pre-hospital residence. At 90 days, mortality was 10.5%, and 87% of patients had returned to their pre-hospital residence, including all patients under 70 years of age. By 365 days, overall mortality was 16.8%, and only 1.5% of patients (all aged >70 years) had not returned to their pre-hospital residence.
CONCLUSION
Patients who survive 90 and 365 days following EL nearly all return to their pre-hospital residence, with only a very small proportion of previously independent patients entering dependent care. This should help inform shared decision-making regarding emergency laparotomy in the acute setting.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
2433-2438Investigateurs
Merran Holmes
(M)
Anya Rugendyke
(A)
Yan Joyce Ming
(YJ)
Peter Howley
(P)
Jon Gani
(J)
Peter Pockney
(P)
Shaun Jones
(S)
Tiffany Gould
(T)
Madelyn Gramlick
(M)
Hannah Coleman
(H)
Jacqueline Hawthorne
(J)
Sam Green
(S)
Daniel Zardawi
(D)
Jacob Hampton
(J)
Gabrielle Francis
(G)
Dilharan Eliezer
(D)
Sergey Vavilov
(S)
Gavin Sullivan
(G)
Giles Devany
(G)
Conor Moyland
(C)
Graeme Wertheimer
(G)
Lauren Garrity
(L)
Michelle Jie Zhao
(MJ)
Brayden March
(B)
Helen Boyd
(H)
Nicholas Blefari
(N)
Andrew Gray
(A)
Paul Liebenberg
(P)
Linda Lin
(L)
Nicholas Bull
(N)
Alison Rutledge
(A)
Joel Petit
(J)
Martin Larisch
(M)
Peter Chen
(P)
Rebecca Anning
(R)
Victoria Jenkins
(V)
Saksham Gupta
(S)
Sam Makanyengo
(S)
Harry Pearce
(H)
Grace Dennis
(G)
Sanjna Gangakhedkar
(S)
Anjelee Segaran
(A)
Antonia Watson
(A)
Amanda Sebastian
(A)
Brent Gilbert
(B)
Chinthan Nayak
(C)
Eloise Williams
(E)
Ellen Weekes
(E)
Harriet Morris-Baguley
(H)
Jett Karolewski
(J)
Jiayue Sophie Zhong
(JS)
Liam Bell
(L)
Lucinda Logan
(L)
Megan Adams
(M)
Reshma Roy
(R)
Sarah Williams
(S)
Vaisnavi Thirugnanasundralingam
(V)
Veral Vishnoi
(V)
Winy Widjaja
(W)
Informations de copyright
© 2023 The Authors. ANZ Journal of Surgery published by John Wiley & Sons Australia, Ltd on behalf of Royal Australasian College of Surgeons.
Références
Burmas M, Aitken RJ, Broughton KJ. Outcomes following emergency laparotomy in Australian public hospitals. ANZ J. Surg. 2018; 88: 998-1002.
NELA Project Team. Seventh Patient Report of the National Emergency Laparotomy Audit RCoA London 2021. https://www.nela.org.uk/reports. Accessed 2 Jan 2023.
Barazanchi A, Xia W, MacFater W et al. Risk factors for mortality after emergency laparotomy: scoping systematic review. ANZ J.Surg. 2020; 90: 1895-1902.
Palaniappan S, Soiza RL, Duffy S, Moug SJ, Myint PK, the Older People's Surgical Outcomes Collaborative (OPSOC), The Emergency Laparoscopic, Laparotomy Scottish Audit (ELLSA). Comparison of the clinical frailty score (CFS) to the National Emergency Laparotomy Audit (NELA) risk calculator in all patients undergoing emergency laparotomy. Colorectal Dis. 2022; 24: 782-789.
Park B, Barazanchi A, Rahiri JL, Xia W, Taneja A, Hill AG. Patient experiences of the emergency laparotomy pathway: a qualitative study. World J. Surg. 2021 May; 45: 1362-1369.
Law J, Welch C, Javanmard-Emamghissi H et al. Decision-making for older patients undergoing emergency laparotomy: defining patient and clinician values and priorities. Colorectal Dis. 2020; 22: 1694-1703.
Australian Bureau of Statistics. Regional population, 2019, https://www.abs.gov.au/statistics/people/population/regional-population. Accessed 2 Jan 2023.
Eliezer DD, Holmes M, Sullivan G, Gani J, Pockney P. High-risk emergency laparotomy in Australia: comparing NELA, P-POSSUM, and ACS-NSQIP calculators. J. Surg. Res. 2020; 246: 300-304.
Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap) - a metadata-driven methodology and workflow process for providing translational research informatics support. J. Biomed. Inform. 2009 Apr; 42: 377-381.
Lawrence VA, Hazuda HP, Cornell JE et al. Functional independence after major abdominal surgery in the elderly. J. Am. Coll. Surg. 2004; 199: 762-772.
Tolstrup MB, Thorup T, Gögenur I. Chronic pain, quality of life and functional impairment after emergency laparotomy. World J. Surg. 2019; 43: 161-168.
Saunders DI, Sinclair RCF, Griffiths B et al. Emergency Laparotomy Follow-Up Study (ELFUS): prospective feasibility investigation into postoperative complications and quality of life using patient-reported outcome measures up to a year after emergency laparotomy. Perioper. Med. (Lond.) 2021; 10: 22.
Kwong E, Neuburger J, Murray D, Black N. Feasibility of collecting and assessing patient-reported outcomes for emergency admissions: laparotomy for gastrointestinal conditions. BMJ Open Gastroenterol. 2018; 5: e000238.
Alder L, Mercer SJ, Carter NC, Toh SK, Knight BC. Clinical frailty and its effect on the septuagenarian population after emergency laparotomy. Ann. R. Coll. Surg. Engl. 2021; 103: 180-185.
ANZELA-QI working Group. Second ANZELA-QI program summary report. RACS, 2022. https://www.surgeons.org/en/research-audit/morbidity-audits/morbidity-audits-managed-by-racs/anz-emergency-laparotomy-audit-quality-improvement. Accessed 2 Jan 2023.
NELA Project Team. Fourth Patient Report of the National Emergency Laparotomy Audit RCoA London, 2018. https://www.nela.org.uk/reports. Accessed 10 Jan 2023.
Carter B, Law J, Hewitt J et al. Association between preadmission frailty and care level at discharge in older adults undergoing emergency laparotomy. Br. J. Surg. 2020; 107: 218-226.
Hajibandeh S, Hajibandeh S, Shah J et al. The risk and predictors of mortality in octogenarians undergoing emergency laparotomy: a multicentre retrospective cohort study. Langenbecks Arch. Surg. 2021; 406: 2037-2044.
Green G, Shaikh I, Fernandes R, Wegstapel H. Emergency laparotomy in octogenarians: a 5-year study of morbidity and mortality. World J. Gastrointest. Surg. 2013; 5: 216-221.
Gazala S, Tul Y, Wagg A, Widder SL, Khadaroo RG, Acute Care and Emergency Surgery (ACES) Group. Quality of life and long-term outcomes of octo- and nonagenarians following acute care surgery: a cross sectional study. World J. Emerg. Surg. 2013; 8: 23.
Vilches-Moraga A, Rowley M, Fox J et al. Emergency laparotomy in the older patient: factors predictive of 12-month mortality-Salford-POPS-GS. An observational study. Aging Clin. Exp. Res. 2020; 32: 2367-2373.
Chiu AS, Jean RA, Resio B, Pei KY. Early postoperative death in extreme-risk patients: a perspective on surgical futility. Surgery 2019; 166: 380-385.
Aggarwal G, Broughton KJ, Williams LJ, Peden CJ, Quiney N. Early postoperative death in patients undergoing emergency high-risk surgery: towards a better understanding of patients for whom surgery may not be beneficial. J. Clin. Med. 2020; 9: 1288.