Department of Surgery, South Auckland Clinical School, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand.
Department of General Surgery, Auckland City Hospital, Auckland District Health Board, Auckland, New Zealand.
ANZ J Surg. 2020 Oct;90(10):1895-1902. doi: 10.1111/ans.16082. Epub 2020 Jun 24.
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.
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.
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.
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.
急诊剖腹手术（EL）是一种常见的高死亡率手术，为此人们做出了许多努力来记录和降低死亡率。目前质量改进项目中使用的风险评分要么需要术中数据，要么不适用于 EL。为了对临床医生/患者有用，估计术前死亡率的风险很重要。我们旨在探讨个体术前危险因素，这些因素可能有助于开发术前死亡率风险评分。
两名独立审查员从 1980 年 1 月至 2018 年 1 月的 MEDLINE、EMBASE 和 Cochrane 数据库中搜索到相关文章。我们选择了仅评估 EL 患者术前死亡率预测因素的研究。
搜索结果筛选出 6648 篇文章，纳入 22 项研究，共纳入 157728 例患者。术后 30 天的总死亡率为 13%。除了一项小型研究外，所有研究的偏倚风险均较低。由于人群和结局的异质性，无法对结果进行荟萃分析。年龄、美国麻醉医师协会、术前败血症、依赖状态、当前癌症和合并症与死亡率增加相关。肾脏、白蛋白和全血细胞计数检测中出现的急性生理紊乱与死亡率密切相关。手术延迟和糖尿病对死亡率没有影响。较高的体重指数具有保护作用。
术前确定的危险因素可用于开发和更新特定于 EL 死亡率的风险评分。本范围综述侧重于术前环境，有助于制定治疗决策。它强调了需要进一步研究来测试新的危险因素（如脆弱性和营养）的相关性。
