Hospital Universitario Mayor, Méderi, Calle 24 #29-45, Bogotá, Colombia.
Universidad del Rosario, Bogotá, Colombia.
BMC Surg. 2023 Jan 27;23(1):21. doi: 10.1186/s12893-022-01897-1.
The number of older patients with multiple comorbidities in the emergency service is increasingly frequent, which implies the risk of incurring in futile surgical interventions. Some interventions generate false expectations of survival or quality of life in patients and families and represent a negligible therapeutic benefit in patients whose chances of survival are minimal. In order to address this dilemma, we describe mortality in a cohort of patients undergoing emergency laparotomy with a risk ≥ 75% per the ACS NSQIP Surgical Risk Calculator.
A retrospective observational study was designed to analyze postoperative mortality and factors associated with postoperative mortality in a cohort of patients undergoing emergency laparotomy between January 2018 and December 2021 in a high-complexity hospital who had a mortality risk ≥ 75% per the ACS NSQIP Surgical Risk Calculator.
A total of 890 emergency laparotomies were performed during the study period, and 50 patients were included for the analysis. Patient median age was 82.5 (IQR: 18.25) years old and 33 (66.00%) were male. The most frequent diagnoses were mesenteric ischemia 21 (42%) and secondary peritonitis 18 (36%). Mortality in the series was 92%. Twenty-four (54.34%) died within the first 24 h of the postoperative period; 11 (23.91%) within 72 h and 10 (21.73%) within 30 days. APACHE II and SOFA scores were statistically significantly higher in patients who died.
All available tools should be used to make decisions, with the most reliable and objective information possible, and be particularly vigilant in patients at extreme risk (mortality risk greater than 75% according to ACS NSQIP Surgical Risk Calculator) to avoid futility and its consequences. The available information should be shared with the patient, the family, or their guardians through an assertive and empathetic communication strategy. It is necessary to insist on a culture of surgical ethics based on reflection and continuous improvement in patient care and to know how to accompany them in order to have a proper death.
急诊科室中患有多种合并症的老年患者数量日益增多，这意味着进行无效手术干预的风险增加。一些干预措施会给患者和家属带来生存或生活质量的虚假期望，而对于生存机会极小的患者来说，这些干预措施的治疗获益微不足道。为了解决这一困境，我们描述了在一个根据 ACS NSQIP 手术风险计算器风险≥75%的患者队列中接受急诊剖腹手术的患者的死亡率。
设计了一项回顾性观察研究，以分析 2018 年 1 月至 2021 年 12 月期间在一家高复杂度医院接受急诊剖腹手术且根据 ACS NSQIP 手术风险计算器风险≥75%的患者队列中的术后死亡率和与术后死亡率相关的因素。
在研究期间共进行了 890 例急诊剖腹手术，其中纳入 50 例患者进行分析。患者中位年龄为 82.5（IQR：18.25）岁，33 例（66.00%）为男性。最常见的诊断是肠系膜缺血 21 例（42%）和继发性腹膜炎 18 例（36%）。该系列的死亡率为 92%。24 例（54.34%）在术后 24 小时内死亡；11 例（23.91%）在 72 小时内死亡，10 例（21.73%）在 30 天内死亡。死亡患者的 APACHE II 和 SOFA 评分均显著升高。
应使用所有可用工具做出决策，并尽可能使用最可靠和客观的信息，并特别警惕处于极端风险（根据 ACS NSQIP 手术风险计算器，死亡率风险大于 75%）的患者，以避免无效和其后果。应通过积极和有同理心的沟通策略与患者、家属或其监护人共享可用信息。有必要坚持基于反思和不断改进患者护理的手术伦理文化，并了解如何陪伴他们，以便进行适当的死亡。
