Fagan Georgina, Barazanchi Ahmed, Coulter Grant, Leeman Matthew, Hill Andrew G, Eglinton Tim W
Department of Surgery, University of Otago, Christchurch Hospital, Christchurch, New Zealand.
Department of Surgery, University of Auckland, Middlemore Hospital, Auckland, New Zealand.
ANZ J Surg. 2021 Dec;91(12):2583-2591. doi: 10.1111/ans.16563. Epub 2021 Jan 28.
Almost 20 000 people undergo an emergency laparotomy each year in New Zealand and Australia. Common indications include small and large bowel obstruction, and intestinal perforation. Considered a high-risk procedure, emergency laparotomy is associated with significantly high morbidity and mortality. The aim of this review was to identify and compare 30-day, 90-day and 1-year mortality rates following emergency laparotomy in New Zealand and Australia.
A systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Electronic searches were performed in Medline, Embase, PubMed and Scopus in April 2020.
Thirty-three papers met the inclusion criteria. Studies ranged in size from 58 to 75 280 patients. Weighted mean 30-day mortality was 8.40% (8.39-8.41). Mortality rates increased with longer postoperative follow up with 90-day weighted mortality rate of 14.14% (14.13-14.15) and the weighted mortality rate at 1 year of 24.60% (24.56-24.66). There was significant variability in mortality rates between countries.
There is a wide variability of 30-day, 90-day and 1-year mortality rates internationally. Lowering postoperative mortality rates following emergency laparotomy through quality improvement initiatives could result in up to 120 lives in New Zealand and over 250 lives in Australia being saved each year. The continued work of the Australian and New Zealand Emergency Laparotomy Audit - Quality Improvement is crucial to improving emergency laparotomy mortality rates further in New Zealand and Australia.
在新西兰和澳大利亚，每年有近2万人接受急诊剖腹手术。常见适应症包括小肠和大肠梗阻以及肠穿孔。急诊剖腹手术被认为是一种高风险手术，其发病率和死亡率显著较高。本综述的目的是确定并比较新西兰和澳大利亚急诊剖腹手术后30天、90天和1年的死亡率。
根据系统评价和Meta分析的首选报告项目（PRISMA）声明进行系统评价。2020年4月在Medline、Embase、PubMed和Scopus中进行了电子检索。
33篇论文符合纳入标准。研究规模从58例到75280例患者不等。加权平均30天死亡率为8.40%（8.39 - 8.41）。随着术后随访时间延长，死亡率上升，90天加权死亡率为14.14%（14.13 - 14.15），1年加权死亡率为24.60%（24.56 - 24.66）。各国之间的死亡率存在显著差异。
国际上30天、90天和1年的死亡率差异很大。通过质量改进措施降低急诊剖腹手术后的死亡率，每年在新西兰可挽救多达120人的生命，在澳大利亚可挽救超过250人的生命。澳大利亚和新西兰急诊剖腹手术审计 - 质量改进的持续工作对于进一步提高新西兰和澳大利亚的急诊剖腹手术死亡率至关重要。
