Shahait Awni D, Dolman Heather, Mostafa Gamal
The Michael and Marian Ilitch Department of Surgery, Wayne State University School of Medicine, Detroit, USA.
Cureus. 2022 Mar 23;14(3):e23426. doi: 10.7759/cureus.23426. eCollection 2022 Mar.
Emergency laparotomy (EL) is a common operation that deals with a wide range of pathologies. Preoperative optimization is often lacking due to the urgent nature of the disease process with a reported mortality rate of up to 44%. This study examines the mortality of EL at an academic acute care surgery medical center.
A retrospective analysis of nontrauma EL from January 2008 to December 2013 was conducted. Data included demographics, clinical features, preoperative laboratory studies, comorbidities, time to surgery, ICU admission, and 30-day mortality.
A total of 234 patients (123 males, 52.6%) were included in the study. EL was performed within four hours (immediate) of presentation in 93 (39.7%) patients, within 4-12 hours (early) in 53 (25.4%) patients, and within 12-24 hours (late) in 63 (30.1%) patients. Overall mortality was 16 (6.8%) at 30 days. Mortality was significantly higher with chronic obstructive pulmonary disease (p = 0.014), blood transfusion (p < 0.001), ICU admission (p < 0.001), ventilator days > four (p = 0.013), hyperlipidemia (p = 0.014), heart rate > 90 beats/minute (p = 0.003), temperature > 38°C or < 35°C (p = 0.013), and systolic blood pressure < 90 mmHg (p < 0.001).
EL can be performed with lower mortality than previously reported. Specific predictors of mortality are identified and can be used for risk assessment.
急诊剖腹手术（EL）是一种常见手术，可处理多种病症。由于疾病进程紧急，术前优化措施往往缺失，据报道死亡率高达44%。本研究考察了一所学术性急性护理外科医疗中心的急诊剖腹手术死亡率。
对2008年1月至2013年12月的非创伤性急诊剖腹手术进行回顾性分析。数据包括人口统计学资料、临床特征、术前实验室检查、合并症、手术时间、重症监护病房（ICU）收治情况以及30天死亡率。
共有234例患者（123例男性，占52.6%）纳入研究。93例（39.7%）患者在就诊后4小时内（即刻）进行了急诊剖腹手术，53例（25.4%）患者在4 - 12小时内（早期）进行手术，63例（30.1%）患者在12 - 24小时内（晚期）进行手术。30天总体死亡率为16例（6.8%）。慢性阻塞性肺疾病（p = 0.014）、输血（p < 0.001）、入住ICU（p < 0.001）、机械通气天数>4天（p = 0.013）、高脂血症（p = 0.014）、心率>90次/分钟（p = 0.003）、体温>38°C或<35°C（p = 0.013）以及收缩压<90 mmHg（p < 0.001）时死亡率显著更高。
急诊剖腹手术的死亡率可低于先前报道。已确定死亡率的特定预测因素，可用于风险评估。
