Department of Anaesthesiology and Perioperative Medicine, Mater Misericordiae University Hospital, Dublin, Ireland.
Clinical Surgery, Mater Misericordiae University Hospital, Dublin, Ireland.
Sci Rep. 2020 Oct 12;10(1):16999. doi: 10.1038/s41598-020-73982-5.
Emergency Laparotomy (EL) is associated with significant morbidity and mortality. Variation in practice and patient outcomes for patients undergoing emergency laparotomy has been identified through the UK National Emergency Laparotomy Audit (NELA), with 30-day mortality ranging from 11 to 15%. A correlation between preoperative haemodynamic parameters and increased postoperative mortality has been demonstrated by both NELA and other observational studies. The association between intraoperative haemodynamic parameters and overall postoperative morbidity has not been evaluated in EL patients. The aims of our study were to investigate the association between perioperative haemodynamic and logistic parameters and postoperative morbidity in a tertiary referral university hospital; and to compare our outcomes to that of the NELA data. A retrospective analysis correlating a range of perioperative parameters with Comprehensive Complication Index (CCI) among 86 patients who underwent EL during 2018 was conducted. Mean age was 64 years (SD 16). Median CCI was 27 [9-45], and 30-day mortality was 11.7%. Several intraoperative parameters correlated with CCI on univariate analysis. On multivariate analysis, ASA status (P = 0.005) and unplanned escalation to postoperative intensive care (P = 0.03) were independently associated with CCI. Our study shows a correlation between ASA status and unplanned escalation to ITU with increased postoperative morbidity in patients undergoing emergency laparotomy. We did not demonstrate an independent correlation between intraoperative parameters and postoperative morbidity. These findings warrant confirmation in a larger scale observational study. Outcomes in our institution are comparable to those seen in the NELA.
急诊剖腹手术（EL）与较高的发病率和死亡率相关。通过英国国家急诊剖腹手术审计（NELA）已经确定了接受急诊剖腹手术的患者在实践和患者结局方面的差异，30 天死亡率范围为 11%至 15%。NELA 和其他观察性研究均表明，术前血流动力学参数与术后死亡率增加之间存在相关性。EL 患者术中血流动力学参数与整体术后发病率之间的关系尚未得到评估。我们的研究目的是调查围手术期血流动力学和逻辑参数与三级转诊大学医院术后发病率之间的关系；并将我们的结果与 NELA 数据进行比较。对 2018 年 86 例接受 EL 的患者的一系列围手术期参数与综合并发症指数（CCI）进行了相关性回顾性分析。平均年龄为 64 岁（SD 16）。CCI 中位数为 27 [9-45]，30 天死亡率为 11.7%。一些术中参数在单变量分析中与 CCI 相关。多变量分析显示，ASA 状态（P=0.005）和术后计划转入重症监护病房（P=0.03）与 CCI 独立相关。我们的研究表明，ASA 状态与计划外转入 ICU 与急诊剖腹手术后患者术后发病率增加之间存在相关性。我们没有证明术中参数与术后发病率之间存在独立相关性。这些发现需要在更大规模的观察性研究中得到证实。我们机构的结果与 NELA 所见结果相当。
