Volume 90, Issue 10 pp. 1895-1902

REVIEW ARTICLE

Risk factors for mortality after emergency laparotomy: scoping systematic review

Corresponding Author

Ahmed W. H. Barazanchi MBChB

[email protected]

orcid.org/0000-0001-7543-0230

Department of Surgery, South Auckland Clinical School, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand

Correspondence

Dr Ahmed W. H. Barazanchi, Department of Surgery, South Auckland Clinical School, Faculty of Medical and Health Sciences, The University of Auckland, South Auckland Clinical Campus, Level 2, Esme Green Building, 100 Hospital Road, Auckland 2025, New Zealand. Email: [email protected]

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Weisi Xia MBChB,

Weisi Xia MBChB

orcid.org/0000-0003-0250-4942

Department of Surgery, South Auckland Clinical School, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand

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Wiremu MacFater MBChB,

Wiremu MacFater MBChB

Department of Surgery, South Auckland Clinical School, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand

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Sameer Bhat BMedSc (Hons),

Sameer Bhat BMedSc (Hons)

orcid.org/0000-0003-3770-8996

Department of Surgery, South Auckland Clinical School, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand

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Hoani MacFater MBChB,

Hoani MacFater MBChB

Department of Surgery, South Auckland Clinical School, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand

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Ashish Taneja MBChB,

Ashish Taneja MBChB

Department of General Surgery, Auckland City Hospital, Auckland District Health Board, Auckland, New Zealand

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Andrew G. Hill MBChB, MD (Thesis), EdD, FACS, FRACS,

Andrew G. Hill MBChB, MD (Thesis), EdD, FACS, FRACS

orcid.org/0000-0001-8672-6379

Department of Surgery, South Auckland Clinical School, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand

Department of General Surgery, Middlemore Hospital, Counties Manukau District Health Board, Auckland, New Zealand

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Ahmed W. H. Barazanchi MBChB,

Corresponding Author

Ahmed W. H. Barazanchi MBChB

[email protected]

orcid.org/0000-0001-7543-0230

Department of Surgery, South Auckland Clinical School, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand

Correspondence

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Weisi Xia MBChB,

Weisi Xia MBChB

orcid.org/0000-0003-0250-4942

Department of Surgery, South Auckland Clinical School, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand

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Wiremu MacFater MBChB,

Wiremu MacFater MBChB

Department of Surgery, South Auckland Clinical School, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand

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Sameer Bhat BMedSc (Hons),

Sameer Bhat BMedSc (Hons)

orcid.org/0000-0003-3770-8996

Department of Surgery, South Auckland Clinical School, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand

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Hoani MacFater MBChB,

Hoani MacFater MBChB

Department of Surgery, South Auckland Clinical School, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand

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Ashish Taneja MBChB,

Ashish Taneja MBChB

Department of General Surgery, Auckland City Hospital, Auckland District Health Board, Auckland, New Zealand

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Andrew G. Hill MBChB, MD (Thesis), EdD, FACS, FRACS,

Andrew G. Hill MBChB, MD (Thesis), EdD, FACS, FRACS

orcid.org/0000-0001-8672-6379

Department of Surgery, South Auckland Clinical School, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand

Department of General Surgery, Middlemore Hospital, Counties Manukau District Health Board, Auckland, New Zealand

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First published: 24 June 2020

https://doi.org/10.1111/ans.16082

Citations: 19

A. W. H. Barazanchi MBChB; W. Xia MBChB; W. MacFater MBChB; S. Bhat BMedSc (Hons); H. MacFater MBChB; A. Taneja MBChB; A. G. Hill MBChB, MD (Thesis), EdD, FACS, FRACS.

This study has been presented at the Royal Australasian College of Surgeons Annual Scientific Congress in 2018 and was awarded best presentation prize in the General Surgery Section.

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Abstract

Background

Emergency laparotomy (EL) is a common procedure with high mortality leading to several efforts to record and reduce mortality. Risk scores currently used by quality improvement programmes either require intraoperative data or are not specific to EL. To be of utility to clinicians/patients, estimation of preoperative risk of mortality is important. We aimed to explore individual preoperative risk factors that might be of use in developing a preoperative mortality risk score.

Methods

Two independent reviewers identified relevant articles from searches of MEDLINE, EMBASE and Cochrane databases from January 1980 to January 2018. We selected studies that evaluated only preoperative predictive factors for mortality in EL patients.

Results

The search yielded 6648 articles screened, with 22 studies included examining 157 728 patients. The combined post-operative 30-day mortality was 13%. All, but one small study, were at low risk of bias. A meta-analysis of results was not possible due to the heterogeneity of populations and outcomes. Age, American Society of Anesthesiologists, preoperative sepsis, dependency status, current cancer and comorbidities were associated with increased mortality. Acute physiological derangements seen in renal, albumin and complete blood count assays were strongly associated with mortality. Delay to surgery and diabetes did not influence mortality. Higher body mass index was protective.

Conclusion

Preoperatively, risk factors identified can be used to develop and update risk scores specific for EL mortality. This scoping review focused on the preoperative setting which helps tailor treatment decisions. It highlights the need for further research to test the relevance of newer risk factors such as frailty and nutrition.

Conflicts of interest

None declared.

Supporting Information

Filename	Description
ans16082-sup-0001-Supinfo.docxWord 2007 document , 13.9 KB	Appendix S1. Search strategy and search terms.
ans16082-sup-0002-TableS1.docxWord 2007 document , 21.6 KB	Table S1. Study design and risk of bias for included studies using the Newcastle–Ottawa quality assessment score.
ans16082-sup-0003-TableS2.docxWord 2007 document , 28.8 KB	Table S2. Influence of patient characteristics on mortality after emergency laparotomy.
ans16082-sup-0004-TableS3.docxWord 2007 document , 17.6 KB	Table S3. Influence of sepsis, functional dependency status and other preoperative variables on mortality after emergency laparotomy.
ans16082-sup-0005-TableS4.docxWord 2007 document , 29.6 KB	Table S4. Influence of comorbidities on mortality following emergency laparotomy.
ans16082-sup-0006-TableS5.docxWord 2007 document , 29.2 KB	Table S5. Influence of acute physiological derangement on mortality following emergency laparotomy.

Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

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Volume90, Issue10

October 2020

Pages 1895-1902

Risk factors for mortality after emergency laparotomy: scoping systematic review

Abstract

Background

Methods

Results

Conclusion

Conflicts of interest

Supporting Information

References

Citing Literature

References

Information

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Risk factors for mortality after emergency laparotomy: scoping systematic review

Abstract

Background

Methods

Results

Conclusion

Conflicts of interest

Supporting Information

References

Citing Literature

References

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