Department of General Surgery, Royal Alexandra Hospital, Paisley, UK.
School of Medicine, University of Glasgow, UK.
Anaesthesia. 2020 Jan;75(1):54-62. doi: 10.1111/anae.14839. Epub 2019 Sep 18.
Patients eligible for emergency laparotomy who do not proceed to surgery are not as well characterised as patients who do proceed to surgery. We studied patients eligible for laparotomy, as defined by National Emergency Laparotomy Audit criteria, from August 2015 to October 2016. We analysed the association of individual variables with survival and two composite scores: P-POSSUM and a general survival model. Out of 314 patients, 214 (68%) underwent laparotomy and 100 (32%) did not. Median (IQR [range]) follow-up was 1.3 (0.1-1.8 [0.0-2.5]) years for the cohort, 1.5 (1.1-2.0 [0.0-2.6]) years after laparotomy and 0.0 (0.0-1.1 [0.0-2.2]) years without laparotomy. There were 126/314 (40%) deaths in the follow-up period, 52/214 (24%) deaths after laparotomy and 74/100 (74%) deaths without surgery. Ninety out of 126 deaths (71%) were within one month of hospital admission. Patient variables were different for the two groups, which when combined in the general survival model generated background median (IQR [range]) life expectancies of 12 (6-21 [0-49]) and 4 (2-6 [0-36]) years, respectively, p < 0.0001. 'Poor fitness' precluded laparotomy in 74/100 (74%) patients. The decision to not operate involved a consultant less often than the decision to operate: 66/100 (66%) vs. 178/214 (83%), p = 0.001. Our study supports the contention that survival beyond 30 postoperative days could be predicted reasonably accurately. Survival in patients who did not have laparotomy was shorter than expected. Emergency laparotomy might have prolonged survival in some patients.
未接受手术的符合急诊剖腹手术条件的患者的特征不如接受手术的患者明确。我们研究了 2015 年 8 月至 2016 年 10 月符合国家急诊剖腹手术审核标准的剖腹手术患者。我们分析了个体变量与生存的关系以及两个综合评分：P-POSSUM 和一般生存模型。在 314 名患者中，214 名（68%）接受了剖腹手术，100 名（32%）未接受。队列的中位（IQR [范围]）随访时间为 1.3 年（0.1-1.8 年[0.0-2.5 年]），剖腹手术后为 1.5 年（1.1-2.0 年[0.0-2.6 年]），未剖腹手术后为 0.0 年（0.0-1.1 年[0.0-2.2 年]）。在随访期间，314 名患者中有 126 名（40%）死亡，214 名患者中有 52 名（24%）死亡，100 名患者中有 74 名（74%）未接受手术。126 例死亡中有 90 例（71%）发生在入院后一个月内。两组患者的个体变量不同，将这些变量合并到一般生存模型中，分别产生背景中位（IQR [范围]）预期寿命为 12 年（6-21 年[0-49 年]）和 4 年（2-6 年[0-36 年]），p<0.0001。“身体状况不佳”导致 100 名患者中的 74 名（74%）无法进行剖腹手术。不手术的决定比手术的决定更不容易被顾问否决：100 名患者中有 66 名（66%）与 214 名患者中有 178 名（83%）相比，p=0.001。我们的研究支持这样一种观点，即在术后 30 天内可以合理地准确预测患者的生存情况。未接受剖腹手术的患者的预期寿命更短。对于某些患者来说，急诊剖腹手术可能延长了他们的生存时间。
