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Background: Post-operative complications remain a significant challenge in patients undergoing emergency laparotomy for peritonitis. This study aimed to evaluate and compare the efficacy of warm saline and metronidazole lavage in reducing surgical site infections, systemic sepsis, burst abdomen, fecal fistula, mortality, and hospital stay duration. METHODS: A prospective study was conducted at Coimbatore Medical College Hospital from January to December 2019 on 100 patients who underwent emergency laparotomy. Participants were randomly assigned into two groups: Group A (warm saline lavage) and Group B (metronidazole lavage). Data on complications and outcomes were collected and analyzed using chi-square test, with a p-value < 0.05 considered significant. Results: Group B showed significantly fewer surgical site infections (10% vs. 30%, p = 0.012), systemic sepsis (14% vs. 32%, p = 0.032), and burst abdomen (2% vs. 14%, p = 0.026). Mortality was lower in Group B (6% vs. 20%, p = 0.037), and 80% of Group B had hospital stays <10 days compared to 52% in Group A (p = 0.003). Conclusion: Metronidazole lavage demonstrated superior efficacy in reducing post-operative complications and hospital stay, making it a preferred method for managing peritonitis in emergency laparotomy patients. [ABSTRACT FROM AUTHOR]

Purpose: Emergency laparotomy (EL) encompasses procedures of varying complexity and urgency, undertaken in different clinical scenarios, leading to different risks of morbidity and mortality. We hypothesized that the increased mortality and longer postoperative length of stay (LoS) observed in frail patients are related to differences in indication for operation, a higher rate of sepsis, worse intraperitoneal soiling, and more advanced malignancy in this group. Methods: This retrospective cohort study analysed patients entered into the National Emergency Laparotomy Audit database between January 1, 2018, and June 15, 2021, in Oxford. The primary outcome was 180-day survival analysed using multivariable Cox regression. The secondary outcomes, delay to surgery (DtS) and postoperative LoS, were analysed using logarithmically transformed multivariable linear regression. Results: Of the 803 patients analysed, 396 (49.3%) were male. The median age was 66, and 337 (42%) were living with at least very mild frailty. Mortality hazard ratios for Clinical Frailty Scale grades 4 (3.93, 95% CI 1.89–8.20), 5 (5.86, 95% CI 2.87–11.97), and 6–7 (14.17, 95% CI 7.33–27.40) were not confounded by indication, sepsis, intraperitoneal soiling, or malignancy status. Frail patients experienced a 1.38-fold longer DtS and a 1.24-fold longer postoperative LoS, even after adjusting for indication, sepsis, intraperitoneal soiling, malignancy status, and DtS. Conclusion: Our results indicate that frail patients have a poorer prognosis and longer postoperative LoS, independent of DtS, indication, sepsis, intraperitoneal soiling, and malignancy status. Patient frailty is also associated with longer DtS. [ABSTRACT FROM AUTHOR]

Background: Surgical site infection (SSI) is a very common complication of emergency laparotomy and causes significant morbidity. The PICO◊ device delivers negative pressure wound therapy (NPWT) to closed incisions, with some studies suggesting a role for prevention of SSI in heterogenous surgical populations. We aimed to compare SSI rates between patients receiving PICO◊ versus conventional dressing post-emergency laparotomy. Secondary objectives were to observe seroma and dehiscence rates, length of stay, days on dressing and patients' wound experience. Methods: This double blinded randomized controlled trial was conducted in University Malaya Medical Centre between October 2019 and March 2022. Patients undergoing emergency laparotomy requiring incisions less than 35 cm were included. Statistical analysis was performed using χ2 test for categorical variables, independent T-test or Mann–Whitney U were used for parametric or non-parametric data respectively besides logistic regression. P values of < 0.05 were considered to be significant. Results: Ninety-six patients were analyzed (47 interventions, 49 controls). The duration on dressing was more consistent in the intervention arm (PICO◊) versus control arm [9.78 ± 10.20 vs 17.78 ± 16.46 days, P < 0.001]. There was a trend towards lower SSI [14.3 vs 4.3%, P = 0.09], dehiscence [27.1 vs 10.6%, P = 0.07] and seroma [40.8 vs 23.4%, P = 0.08] rates in the intervention arm but this did not reach statistical significance. Length of stay [9 (IQR: 6–14) vs 11 (IQR: 6–22.5) days, P = 0.18] was fairly similar between the two arms, but more patients were very satisfied with PICO◊ compared to the conventional dressing [80% vs 57.1%, P = 0.03]. Conclusion: The use of NPWT in emergency laparotomy improves patients wound care experience, and was associated with trends towards fewer wound related complications. Cost effectiveness needs to be explored in order to further validate its use in the emergency setting, especially for patients with additional risk for SSI. Trial registration National Medical Research Registry (NMRR): NMRR-20-1975-55222. [ABSTRACT FROM AUTHOR]

Objective: To determine the effect of anemia in patient undergoing emergency laparotomy and post-operative complications. Study Design: Prospective observational study. Setting: We monitored individuals having emergency laparotomies at a tertiary care hospital. Period: June 2021 to May 2023. Methods: Patients undergoing emergency laparotomies for various reasons. Post-operative complications were the main variable noted in this study. Estimation of risk for complications analyses by using Poisson regression method in patient with anemia. Approval was obtained from the local ethics committee with reference number: SMC/0058. Results: About 76 patients, mostly male (79.3) with median age of 42 years. Complications were noted in 16.3% (12). 14 patients (23%) were pre-operatively anemic at time of operation. Patients with moderate to severe anemia had more complications post-operatively (96% CI). Conclusion: Anemia increase the risk of complications and morbidity of patients undergoing emergency laparotomies due to various reasons but anemia is amenable to increase the morbidity and complications post-operatively. [ABSTRACT FROM AUTHOR]

Background: Acute intestinal obstruction is a blockage of the intestine which causes a range of clinical symptoms such as acute and severe abdominal pain, nausea, and obstipation. Intestinal obstruction is a medical emergency and can be life‐threatening when left untreated. In cases where treatment involves emergency abdominal surgery, a multimodal perioperative care pathway (enhanced recovery after surgery ERAS) has shown to accelerate patient recovery after surgery, reduce hospital length of stay, and improve overall outcomes. The objective of this scoping review was to identify and synthesize the existing evidence regarding the implementation of ERAS components with a focus on postoperative components in patients undergoing surgery for acute intestinal obstruction. Methods: This scoping review followed the preferred reporting items for systematic reviews and meta‐analysis extension for scoping reviews framework. PubMed‐Medline and Embase database were searched. Results: The search identified 1860 studies of which 16 were included in the final analysis. All the studies were quantitative. Eleven studies used 10 or more ERAS interventions (range 10–28). The most common interventions were multimodal systemic analgesia, and the least common were the management of blood glucose and screening tools. Conclusion: This scoping review found that 56% (n = 9/16) of the identified studies used 10 or more ERAS interventions out of a possible 35. This review highlighted the need for studies on the ERAS emergency laparotomy guidelines. [ABSTRACT FROM AUTHOR]

Background: Emergency laparotomies are high-risk surgical procedures often complicated by various postoperative outcomes. Diabetic patients are known to have higher morbidity and mortality rates due to their compromised immune status and delayed wound healing. This study aims to compare postoperative complications and mortality between diabetic and non-diabetic patients undergoing emergency laparotomies. Materials and Methods: This observational study was conducted over six months in the Department of General Surgery at Narayan Medical College and Hospital, Jamuhar. 200 patients, aged 18 years and above, who underwent emergency laparotomies were included. Patients were divided into two groups: diabetic (n=20) and non-diabetic (n=180). Immunocompromised patients (excluding diabetics), patients with malignancies, gynecological and urological emergencies, and pediatric patients were excluded. Data were collected through detailed history, general and systemic examinations, and relevant laboratory and radiological investigations. Preoperative prophylactic antibiotics were administered. Statistical analysis was performed using appropriate tests, with a p-value of less than 0.05 considered significant. Results: Postoperative complications were observed in 70% of diabetic patients and 40% of non-diabetic patients. The most common complications included wound infection (50% in diabetics vs. 20% in non-diabetics), sepsis (20% in diabetics vs. 10% in non-diabetics), and prolonged hospital stay (30% in diabetics vs. 10% in non-diabetics). Mortality rates were higher in diabetic patients (20%) compared to non-diabetic patients (10%). Conclusion: Diabetic patients undergoing emergency laparotomies exhibit a higher incidence of postoperative complications and mortality compared to non-diabetic patients. This underscores the need for meticulous perioperative management and targeted interventions to improve surgical outcomes in diabetic patients. [ABSTRACT FROM AUTHOR]

Aim: To evaluate effect of surgeon's seniority (trainee surgeon vs. consultant surgeon) and surgeon's subspeciality interest on postoperative mortality in patients undergoing emergency laparotomy (EL). Method: A systematic review was conducted and reported according to the Cochrane Handbook for Systematic Reviews and the PRISMA statement standards, respectively. We evaluated all studies comparing the risk of postoperative mortality in patients undergoing EL between (a) trainee surgeon and consultant surgeon, and (b) surgeon without and with subspeciality interest related to pathology. Random effects modelling was applied for the analyses. The certainty of evidence was assessed using the GRADE system. Results: Analysis of 256 844 patients from 13 studies showed no difference in the risk of postoperative mortality between trainee‐led and consultant‐led EL (OR: 0.76, p = 0.12). However, EL performed by a surgeon without subspeciality interest related to the pathology was associated with a higher risk of postoperative mortality compared with a surgeon with subspeciality interest (OR: 1.38, p < 0.00001). In lower gastrointestinal (GI) pathologies, EL done by upper GI surgeons resulted in higher risk of mortality compared with lower GI surgeons (OR: 1.43, p < 0.00001). In upper GI pathologies, EL done by lower GI surgeons resulted in higher risk of mortality compared with upper GI surgeons (OR: 1.29, p = 0.05). Conclusion: While confounding by indication cannot be excluded, level 2 evidence with moderate certainty suggests that trainee‐led EL may not increase the risk of postoperative mortality but EL by a surgeon with subspeciality interest related to the pathology may reduce the risk of mortality. [ABSTRACT FROM AUTHOR]

Emergency laparotomy is a surgical procedure associated with significantly higher mortality rates compared to elective surgeries. Awake laparotomy under neuraxial anaesthesia has recently emerged as a promising approach in abdominal surgery to improve patient outcomes. This study aims to evaluate the feasibility and potential benefits of using neuraxial anaesthesia as the primary anaesthetic technique in emergency laparotomies. We conducted a case series involving 16 patients who underwent emergency laparotomy for bowel ischemia, perforation, or occlusion. Neuraxial anaesthesia was employed as the main anaesthetic technique. We analysed patient demographics, clinical characteristics, intraoperative details, and postoperative outcomes. The primary outcome measures included the adequacy of postoperative pain control, the incidence of postoperative complications, and mortality rates. Among the 16 patients, adequate postoperative pain control was achieved, with only 2 patients requiring additional analgesia. Postoperative complications, including sepsis, wound dehiscence, and pneumonia, were observed in seven patients (44%). The observed mortality rate was relatively low at 6% (one patient). Notably, conversion to general anaesthesia was not necessary in any of the cases, and no early readmissions were reported. Our findings highlight the feasibility and potential benefits of using neuraxial anaesthesia in emergency laparotomies. The observed low mortality rate and the avoidance of conversion to general anaesthesia suggest that neuraxial anaesthesia may be a useful alternative in emergency settings. However, the occurrence of postoperative complications in 44% of patients indicates the need for cautious patient selection and close monitoring. Further research with larger sample sizes is warranted to fully elucidate the efficacy, safety, and potential impact of this technique on patient outcomes in emergency laparotomies. [ABSTRACT FROM AUTHOR]

Background: Health‐related quality of life (HRQoL) is a multidimensional concept used to examine the impact of patient‐perceived health status on quality of life. Patients' perception of illness affects outcomes in both medical and elective surgical patients; however, not much is known about how HRQoL effects outcomes in the emergency surgical setting. This study aimed to examine if patient‐reported HRQoL was a predictor of unplanned readmission after emergency laparotomy. Methods: This study included 215 patients who underwent emergency laparotomy at the Copenhagen University Hospital, Herlev, between August 1, 2021, and July 31, 2022. Patient‐reported HRQoL was assessed with the EuroQol group EQ5D index (EQ5D5L descriptive system and EQ‐VAS). The population was followed from 0 to 180 days after discharge, and readmissions and days alive and out of hospital were registered. A Cox proportional hazard model was used to examine HRQoL and the risk of readmission within 30 and 180 days. Results: Within 30 days, 28.4% of patients were readmitted; within 180 days, the number accumulated to 45.1%. Low self‐evaluated HRQoL predicted 180‐day readmission and was significantly associated with fewer days out of hospital within both 90 and 180 days. Low HRQoL and discharge with rehabilitation were independent risk factors for short‐ (30‐day) and long‐term (180‐day) emergency readmission. Conclusion: Patient‐perceived quality of life is an independent predictor of 180‐day readmission, and the number of days out of hospital was correlated to self‐reported HRQoL. [ABSTRACT FROM AUTHOR]

Introduction: Patients undergoing emergency abdominal surgery for inflammatory bowel disease (IBD) are a complex cohort who are relatively poorly represented in published literature. This is partly due to the lack of consensus of the definition of the term emergency in IBD surgery. There is ongoing and recent work defining clinical urgency for unplanned surgical procedures and categorizing the high‐risk surgical patient. This paper aims to report the difference in patient metrics and risks as recorded by the National Emergency Laparotomy Audit (NELA). Methods: Complete patient data, including histology, were available in the NELA database between 2013 and 2016. Urgency categories recorded by NELA are <2 h, 2–6 h, 6–18 h, and >18 h. Patient characteristics, physiology, biochemistry, and outcomes are reported according to these urgency categories with regression analysis used to compare differences between them. Results: Mortality in Crohn's disease (CD) ranged from 1.4% in the >18 h urgency to 14.6% in the most urgent. In ulcerative colitis (UC), this range was from 3.1% to 14.8%. In both CD and UC, there were significant trends in hemodynamic instability, serum white cell count, serum electrolytes and creatinine, and outcome measures length of stay and unplanned return to theater. Conclusions: Patients having emergency surgery for IBD are not a single cohort when considering physiology, blood biochemistry, or most importantly, outcomes. Risk counseling and management should reflect this. Hemodynamic changes are subtle and may be missed in this cohort. [ABSTRACT FROM AUTHOR]

Background: Preoperative assessment of risk for emergency laparotomy may enhance decision making with regards to urgency or perioperative critical care admission and promote a more informed consent process for patients. Accordingly, we aimed to assess the performance of risk assessment tools in predicting mortality after emergency laparotomy. Methods: PubMed, Embase, the Cochrane Library and CINAHL were searched to 12 February 2022 for observational studies reporting expected mortality based on a preoperative risk assessment and actual mortality after emergency laparotomy. Study screening, data extraction, and risk of bias using the Downs and Black checklist were performed in duplicate. Data on setting, operation undertaken, expected and actual mortality rates were extracted. Meta-analysis was planned but not possible due to heterogeneity. This study is registered with PROSPERO, CRD42022299227. Results: From 10,168 records, 82 observational studies were included. 17 risk assessment tools were described, the most common of which were P-POSSUM (42 studies), POSSUM (13 studies), NELA (12 studies) and MPI (11 studies). Articles were published between 1990 and 2022 with the most common country of origin being the UK (33 studies) followed by India (11 studies). Meta-analysis was not possible. Observed mortality and expected mortality based on risk assessment is reported for each study and generally shows most studies show accurate risk prediction. Conclusions: This review synthesises available literature to characterise the performance of various risk assessment tools in predicting mortality after emergency laparotomy. Findings from this study may benefit those undertaking emergency laparotomy and future research in risk prediction.

Background: The indications for emergency laparotomy are many, depending on different pathological causes, organs involved, and preoperative management. All these factors limit the time to optimize the comorbidities that may affect the outcome of surgery in terms of morbidity and mortality. Objectives: We aimed to detect the different predicting factors for morbidity and mortality after emergency laparotomies.Materials and methods: This prospective cohort study was conducted on 100 patients who were subjected to an emergency laparotomy. The demographic and clinical characteristics of the enrolled participants were registered. The study was carried out at Duhok Emergency Teaching Hospital from February 2022 to January 2023. Patients were followed for 30 days after surgery.Results: The mean age of the patients was 39.26 years ± 19.53, and males constituted 2/3rd of the cases. The non-traumatic causes comprised the majority of cases. Patients with acute abdomen and intestinal obstruction comprised 74% of the cases. The commonest imaging finding was intra-abdominal collections (35%). The commonest operative finding was perforated gastric or duodenal ulcer (19%). Morbidity was reported in 69 patients. These included wound infection, anastomotic leakage, bleeding, deep venous thrombosis, and burst abdomen. There was a significant association (P-value < 0.05) between the morbidity and the age of the patient (OR: 1.5), body weight (OR: 1.9), associated comorbidities (OR: 1.2), operative time (OR: 1.76), performance of bowel anastomosis (OR: 5.5), and admission to the intensive care unit (ICU) (OR: 2.79). Mortality was reported in 9 patients, and there was a significant association (P-value < 0.05) with anastomotic leakage (OR: 4.27), need for anti-coagulation (OR: 23.65), and admission to the ICU (OR: 16.36).Conclusion: Emergency laparotomy is associated with high incidences of morbidity and mortality. The patient's age, body weight, associated comorbidities, operative time, performance of bowel anastomosis, and admission to the ICU might be risk factors for morbidity. High mortality might be due to anastomotic leakage, the requirement of anticoagulation, and ICU admission.

Abstract Background The high rate of stoma placement during emergency laparotomy for secondary peritonitis is a paradigm in need of change in the current fast-track surgical setting. Despite growing evidence for the feasibility of primary bowel reconstruction in a peritonitic environment, little data substantiate a surgeons’ choice between a stoma and an anastomosis. The aim of this retrospective analysis is to identify pre- and intraoperative parameters that predict the leakage risk for enteric sutures placed during source control surgery (SCS) for secondary peritonitis. Methods Between January 2014 and December 2020, 497 patients underwent SCS for secondary peritonitis, of whom 187 received a primary reconstruction of the lower gastro-intestinal tract without a diverting stoma. In 47 (25.1%) patients postoperative leakage of the enteric sutures was directly confirmed during revision surgery or by computed tomography. Quantifiable predictors of intestinal suture outcome were detected by multivariate analysis. Results Length of intensive care, in-hospital mortality and failure of release to the initial home environment were significantly higher in patients with enteric suture leakage following SCS compared to patients with intact anastomoses (p

Background Ovarian pregnancy is a rare type of ectopic pregnancy, accounting for 0.5% to 1% of all ectopic pregnancies, with an incidence ranging from 1 in 2,100 to 1 in 60,000 pregnancies. Due to its rarity and the lack of common risk factors, diagnosing ovarian pregnancy is often challenging and typically occurs during surgical exploration. Case Presentation We present the case of a 40-year-old woman who experienced severe pelvic pain, light vaginal bleeding, and 8 weeks of amenorrhea. Upon arrival at the hospital, she was hemodynamically unstable, with low blood pressure and a rapid heart rate. An ultrasound revealed an empty uterus, an irregular mass on her right ovary, and free fluid in the pelvis. Her beta-hCG level was elevated, and her hemoglobin level was low. Given the suspicion of an ectopic pregnancy, she underwent emergency surgery. During the operation, the surgical team discovered a large amount of clotted blood and a ruptured mass on her left ovary measuring 10 x 9.5 cm. Due to heavy bleeding, they performed a left oophorectomy and salpingectomy. Histopathological analysis later confirmed the diagnosis of ovarian pregnancy. Conclusion This case underscores the challenges in diagnosing ovarian pregnancy and highlights the necessity for prompt surgical intervention, particularly in unstable patients. Early detection and appropriate management are critical to prevent life-threatening complications.

Background: We (1) describe West Australian (WA) older adults undergoing emergency laparotomy (EL) in a tertiary‐centre Acute Surgical Unit (ASU) with proactive geriatrician input and (2) explore the impact of Clinical Frailty Scale (CFS) and Charlson's Comorbidity Index (CCI) on patient outcomes. Methods: We performed a prospective cohort‐study of older adults undergoing EL, between April 2021 and April 2022, in a tertiary ASU, with dedicated geriatrician‐led perioperative care via the Older Adult Surgical Inpatient Service (OASIS). Results: Of 114 patients, average age was 76.7 ± 7.61 years‐old (range 65–96), with 35.1% (n = 40) frail (CFS 5–7), 18.4% (n = 21) vulnerable (CFS 4) and 46.5% (n = 74) not frail (CFS 1–3). 61.4% (n = 70) were severely comorbid (CCI ≥5), 34.2% (n = 39) moderately comorbid (CCI 3–4), and 4.4% (n = 5) mildly comorbid (CCI 1–2). 95.9% (n = 109) EL patients were reviewed by OASIS. Inpatient mortality was 7.9% (n = 9) and 1‐year mortality 16.7% (n = 19). Majority, 64.9% (n = 74), were discharged directly home with 17.5% (n = 20) discharged with in‐home rehabilitation. Each increment in CCI was associated with increased in‐hospital (HR 1.38, p = 0.034) and 1‐year (HR 1.39, p = 0.006) mortality, and each increment in CFS with 1‐year mortality (HR 1.62, p = 0.016). Higher CFS but not CCI was associated with increased level of care at discharge. Age was not statistically significant with any outcomes. Conclusion: We describe demographics, frailty and comorbidity of 114 older adults undergoing EL in ASU. We suggest CFS and CCI as independent risk‐stratification tools, and proactive management of both comorbidity, and frailty, should be incorporated into preoperative optimisation. [ABSTRACT FROM AUTHOR]

Background: The high rate of stoma placement during emergency laparotomy for secondary peritonitis is a paradigm in need of change in the current fast-track surgical setting. Despite growing evidence for the feasibility of primary bowel reconstruction in a peritonitic environment, little data substantiate a surgeons' choice between a stoma and an anastomosis. The aim of this retrospective analysis is to identify pre- and intraoperative parameters that predict the leakage risk for enteric sutures placed during source control surgery (SCS) for secondary peritonitis. Methods: Between January 2014 and December 2020, 497 patients underwent SCS for secondary peritonitis, of whom 187 received a primary reconstruction of the lower gastro-intestinal tract without a diverting stoma. In 47 (25.1%) patients postoperative leakage of the enteric sutures was directly confirmed during revision surgery or by computed tomography. Quantifiable predictors of intestinal suture outcome were detected by multivariate analysis. Results: Length of intensive care, in-hospital mortality and failure of release to the initial home environment were significantly higher in patients with enteric suture leakage following SCS compared to patients with intact anastomoses (p < 0.0001, p = 0.0026 and p =0.0009, respectively). Reduced serum choline esterase (sCHE) levels and a high extent of peritonitis were identified as independent risk factors for insufficiency of enteric sutures placed during emergency laparotomy. Conclusions: A preoperative sCHE < 4.5 kU/L and generalized fecal peritonitis associate with a significantly higher incidence of enteric suture insufficiency after primary reconstruction of the lower gastro-intestinal tract in a peritonitic abdomen. These parameters may guide surgeons when choosing the optimal surgical procedure in the emergency setting. [ABSTRACT FROM AUTHOR]

We aimed to study the relationship between mortality following emergency laparotomy (EL) in elderly patients and admission to a hospital facility, hypothesizing that patients initially admitted to a general surgery service have a better outcome. A retrospective review of the medical records of all the elderly patients (≥65 years) who underwent EL over three years was conducted in a single tertiary medical center. The outcomes evaluated include postoperative morbidity, mortality, discharge destination, and readmission. A total of 200 patients were eligible for this study; 106 (53%) were male, with a mean age of 77 ± 8.3 years. The mortality rate was 29.5% (59 patients), and 55% of all patients were discharged home after initial admission. Bowel obstruction was the most common indication for surgery (91, 45.5%). Patients undergoing an operation from non-general surgical services had higher readmission, unfavorable discharge and mortality rates, a greater incidence of stoma formation, and required a tracheostomy or were TPN-dependent (all p < 0.001). The mortality rate is higher in elderly patients needing an EL when initially admitted through a non-general surgery service. A correct and rapid initial diagnosis and decision are crucial when treating elderly individuals; initial admission to a general surgery service increases the probability of discharge home. [ABSTRACT FROM AUTHOR]

Aims/Background Poorly controlled pain is common after emergency laparotomy. It causes distress, hinders rehabilitation, and predisposes to complications: prolonged hospitalisation, persistent pain, and reduced quality of life. The aim of this systematic review was to compare the relative efficacies of pre-emptive analgesia for emergency laparotomy to inform practice. Methods We performed a search of MEDLINE, MEDLINE In-Process, Embase, PubMed, Web of Science and SCOPUS for comparator studies of preoperative/intraoperative interventions to control/reduce postoperative pain in adults undergoing emergency laparotomy (EL) for general surgical pathologies. Exclusion criteria: surgery including non-abdominal sites; postoperative sedation and/or intubation; non-formal assessment of pain; non-English manuscripts. All manuscripts were screened by two investigators. Results We identified 2389 papers. Following handsearching and removal of duplicates, 1147 were screened. None were eligible for inclusion, with many looking at elective and/or laparoscopic surgeries. Conclusion Our findings indicate there is no evidence base for pre-emptive analgesic strategies in emergency laparotomy. This contrasts substantially with elective cohorts. Potential reasons include variation in practice, management of physiological derangement taking priority, and perceived contraindications to neuraxial techniques. We urge a review of contemporary practice, with analysis of clinical data, to generate expert consensus. [ABSTRACT FROM AUTHOR]

Background: The indications for emergency laparotomy are many, depending on different pathological causes, organs involved, and preoperative management. All these factors limit the time to optimize the comorbidities that may affect the outcome of surgery in terms of morbidity and mortality. Objectives: We aimed to detect the different predicting factors for morbidity and mortality after emergency laparotomies. Materials and methods: This prospective cohort study was conducted on 100 patients who were subjected to an emergency laparotomy. The demographic and clinical characteristics of the enrolled participants were registered. The study was carried out at Duhok Emergency Teaching Hospital from February 2022 to January 2023. Patients were followed for 30 days after surgery. Results: The mean age of the patients was 39.26 years ± 19.53, and males constituted 2/3rd of the cases. The non-traumatic causes comprised the majority of cases. Patients with acute abdomen and intestinal obstruction comprised 74% of the cases. The commonest imaging finding was intra-abdominal collections (35%). The commonest operative finding was perforated gastric or duodenal ulcer (19%). Morbidity was reported in 69 patients. These included wound infection, anastomotic leakage, bleeding, deep venous thrombosis, and burst abdomen. There was a significant association (P-value < 0.05) between the morbidity and the age of the patient (OR: 1.5), body weight (OR: 1.9), associated comorbidities (OR: 1.2), operative time (OR: 1.76), performance of bowel anastomosis (OR: 5.5), and admission to the intensive care unit (ICU) (OR: 2.79). Mortality was reported in 9 patients, and there was a significant association (P-value < 0.05) with anastomotic leakage (OR: 4.27), need for anti-coagulation (OR: 23.65), and admission to the ICU (OR: 16.36). Conclusion: Emergency laparotomy is associated with high incidences of morbidity and mortality. The patient’s age, body weight, associated comorbidities, operative time, performance of bowel anastomosis, and admission to the ICU might be risk factors for morbidity. High mortality might be due to anastomotic leakage, the requirement of anticoagulation, and ICU admission. [ABSTRACT FROM AUTHOR]

Background: An increasing number of older patients are undergoing emergency laparotomy (EL). Frailty is thought to contribute to adverse outcomes in this group. The best method to assess frailty and impacts on long‐term mortality and other important functional outcomes for older EL patients have not been fully explored. Methods: A prospective multicenter study of older EL patients was conducted across four hospital sites in New Zealand from August 2017 to September 2022. The Clinical Frailty Scale (CFS) was used to measure frailty—defined as a CFS of ≥5. Primary outcomes were 30‐day and one‐year mortality. Secondary outcomes were postoperative morbidity, admission for rehabilitation, and increased care level on discharge. A multivariate logistic regression analysis was conducted, adjusting for age, sex, and ethnicity. Results: A total of 629 participants were included. Frailty prevalence was 14.6%. Frail participants demonstrated higher 30‐day and 1‐year mortality—20.7% and 39.1%. Following adjustment, frailty was directly associated with a significantly increased risk of short‐ and long‐term mortality (30‐day aRR 2.6, 95% CI 1.5, 4.3, p = <0.001, 1‐year aRR 2.0, 95% CI 1.5, 2.8, p < 0.001). Frailty was correlated with a 2‐fold increased risk of admission for rehabilitation and propensity of being discharged to an increased level of care, complications, and readmission within 30 days. Conclusion: Frailty was associated with increased risk of postoperative mortality up to 1‐year and other functional outcomes for older patients undergoing EL. Identification of frailty in older EL patients aids in patient‐centered decision‐making, which may lead to improvement in outcomes. [ABSTRACT FROM AUTHOR]

Small bowel internal hernias (IHs), a rare cause of small bowel occlusion (SBO) and small bowel strangulation, while more commonly seen in young adults, can also affect elderly patients and pose a significant diagnostic challenge due to their nonspecific symptoms. In most cases, laparotomy was used to diagnose IHs. However, multidetector computed tomography (MDCT) is usually the best imaging tool to use in the emergency setting for the diagnosis of IHs. An 83-year-old man was admitted to emergency with acute abdominal pain and a coffee-ground vomitus. The abdominal MDCT showed a clustered-like appearance of proximal jejunal loops at the level of the Treitz ligament with the absence of transit of the medium water-soluble iodine oral contrast agent (Gastrografin). Mesenteric edema was also present with initial suffering of the intestinal wall. A left paraduodenal hernia (LPDH) with strangulation was suspected following the radiological report. The emergency laparotomy revealed about 20 cm of proximal jejunal loops herniated through a 3 cm wide hernia orifice (HO) along the Treitz ligament, at the level of Landzert fossa, located in the confluence of the descending mesocolon, posterior to the inferior mesenteric vein (IMV) and confirming the LPDH. The patient was discharged in good condition some days later. IHs do not have sufficient coverage in literature, especially in cases regarding elderly patients, however, they can be a cause of SBO in people older than 80 years of age. Radiologists and surgeons should be aware of the anatomical aspects of the IHs.

Abstract Background Emergency laparotomy is a commonly performed surgical procedure that has higher post-operative morbidity and mortality than elective surgery. Previous research has identified that patients valued postoperative quality of life (QoL) more than the risk of mortality when deciding to undergo emergency surgery. Current pre-operative scoring and risk stratification systems for emergency laparotomy do not account for or provide prediction tools for post-operative QoL. This study aims to systematically review previous literature to determine post-operative QoL in patients who undergo emergency laparotomy. Methods A literature search was undertaken in Medline, EMBASE and the Cochrane Library to identify studies measuring post-operative QoL in patients who have had emergency laparotomy up to 29th April 2023. Mean QoL scores from the studies included were combined to calculate the average effect of emergency laparotomy on QoL. The primary outcome of the review was postoperative QoL after emergency laparotomy when compared with a comparator group. Secondary outcomes included the quality of included studies. Results Ten studies in the literature assessing the QoL of patients after emergency laparotomy were identified. Three studies showed that patients had improved QoL and seven showed worse QoL following emergency laparotomy. Length of time for QoL to return to baseline varied ranged from 3 to 12 months post-operatively. Length of hospital stay was identified as an independent risk factor for poorer QoL post-surgery. Conclusions Outcome reporting for patients who undergo emergency laparotomy should be expanded further to include QoL. Further work is required to investigate this and elicit factors that can improve QoL post-operatively.

Concerning the perioperative outcomes of patients diagnosed with COVID-19 who underwent emergency laparotomy, more data must be collected. Because COVID-19 can affect multiple organs, cause various complications, and act as a risk factor for surgery, in this study, we aimed to compare the outcomes of emergency laparotomy between SARS-CoV-2 infected and uninfected patients. This retrospective cohort study was conducted on patients who underwent emergency laparotomy from December 2021 to December 2022. Postoperative outcomes were compared between patients with and without confirmed perioperative SARS-CoV-2 infection. The primary outcome was 30-day mortality. Secondary outcomes were postoperative intensive care unit admission, hospital length of stay, re-operation, and postoperative complications. Data were analyzed by SPSS statistic version 27. In this study, 50 patients in the COVID-19 group and 91 patients in the non-COVID-19 group were assessed. The 30-day mortality in the COVID-19 group was significantly higher than in the non-COVID-19 group (34% vs. 12.1%, respectively, P = 0.004). Postoperative complications were significantly higher in the COVID-19 group (64% vs. 26.4%, P < 0.001). The frequency of ICU admission and need for re-operation were significantly higher in the COVID-19 group (P = 0.003 and P = 0.039, respectively). Length of hospital stay was significantly lower in the non-COVID-19 group (P = 0.021). In patients with confirmed COVID-19, emergency laparotomy is associated with increased postoperative morbidity and mortality. Additionally, emergency laparotomy is associated with increasing postoperative complications, length of hospital stay, intensive care admission, and additional surgery requirement. [ABSTRACT FROM AUTHOR]

Background: Emergency laparotomy is a commonly performed surgical procedure that has higher post-operative morbidity and mortality than elective surgery. Previous research has identified that patients valued postoperative quality of life (QoL) more than the risk of mortality when deciding to undergo emergency surgery. Current pre-operative scoring and risk stratification systems for emergency laparotomy do not account for or provide prediction tools for post-operative QoL. This study aims to systematically review previous literature to determine post-operative QoL in patients who undergo emergency laparotomy. Methods: A literature search was undertaken in Medline, EMBASE and the Cochrane Library to identify studies measuring post-operative QoL in patients who have had emergency laparotomy up to 29th April 2023. Mean QoL scores from the studies included were combined to calculate the average effect of emergency laparotomy on QoL. The primary outcome of the review was postoperative QoL after emergency laparotomy when compared with a comparator group. Secondary outcomes included the quality of included studies. Results: Ten studies in the literature assessing the QoL of patients after emergency laparotomy were identified. Three studies showed that patients had improved QoL and seven showed worse QoL following emergency laparotomy. Length of time for QoL to return to baseline varied ranged from 3 to 12 months post-operatively. Length of hospital stay was identified as an independent risk factor for poorer QoL post-surgery. Conclusions: Outcome reporting for patients who undergo emergency laparotomy should be expanded further to include QoL. Further work is required to investigate this and elicit factors that can improve QoL post-operatively. [ABSTRACT FROM AUTHOR]

An ectopic pregnancy occurs when the fertilized egg is implanted and develops outside the endometrium, i.e. in the fallopian tubes, cervix, ovary, or abdomen. It commonly presents with a history of amenorrhoea, lower abdominal pain, and slight vaginal bleeding. The fallopian tube is the most typical location for ectopic pregnancy. Two percent of reported pregnancies are ectopic pregnancy. Ectopic pregnancy remains a public health threat for women in reproductive age, and a major cause of maternal mortalities in the first trimester. In East Africa, these reports are limited, despite a great need for documentation addressing key considerations for diagnosis and management of ectopic pregnancy in these resource limited settings. In this case study, we report on 26-years-old female Gravida 5 Para 4 Living 4, who reported history of amenorrhoea for 3 months complaining of slight per vagina bleeding and lower abdominal pain for 5 days more marked at left iliac region along with generalized weakness for 2 weeks. Her vitals were stable. Pelvic ultrasound revealed empty uterus and live fetus at the left adnexa corresponding to 14 weeks 6 days with minimal free fluid in the Douglas Cul-de-sac. The patient's final diagnosis was live extra-uterine pregnancy at 14 weeks 6 days that was managed by emergency laparotomy with salpingectomy. The patient recovered completely after surgery and was discharged in a stable condition. Ectopic pregnancy still remains one of the major causes of maternal morbidity and mortality. Early diagnosis and referral in hemodynamically state along with use of minimal access surgery or management can change the scenario of ectopic pregnancy in the developing world. Late attendance to first visit clinics is still a major concern in low resource limited settings as this could have been picked early and intervened. Key message: Management of broad ligament ectopic pregnancy in the second trimester is still challenging especially in low resource settings where the clients do not attend clinics and because of unavailability of ultrasound machines to diagnose it. [ABSTRACT FROM AUTHOR]

Introduction: Antiphospholipid syndrome (APS) is a systemic autoimmune disorder characterized by antiphospholipid antibodies (aPL), leading to a hypercoagulable state and an increased risk of thrombotic events. While abdominal complications have been reported as the initial presentation of APS in some cases, these instances are predominantly observed in female patients. Here, we present a case of a 49-year-old male patient who presented with complaints and a CT scan mimicking intestinal ileus. However, no mechanical or other evident cause of ileus could be found on the explorative laparotomy. After an uneventful postoperative hospitalization and being discharged in good condition, the patient was readmitted within two weeks, and this time, an extensive small bowel resection due to ischemia was done. After going home in a good and stable condition, he presents again, but this time with cerebral ischemia. Further investigations led to the APS diagnosis. With this case, we want to emphasize the importance of being aware of and considering the diagnosis of APS, especially in cases with repeated, unexplained abdominal pain and non-typical complaints, even in male patients. An early diagnosis could prevent a more complex disease complication. Conclusion: This case underscores the importance of considering APS in the differential diagnosis of unexplained abdominal pain, particularly in male patients with a history of thrombotic events or elevated aPL levels. Heightened awareness of APS in the emergency setting can facilitate timely diagnosis and appropriate management, ultimately optimizing patient care and outcomes.

Objective: To instantly stop life threatening abdominal bleeding (e.g., a ruptured abdominal aneurysm), every surgeon should be familiar with the principles of emergency laparotomy (EL) and aortic clamping. Simulation training in a safe environment can be used to rehearse these situations like other medical emergencies. Owing to the lack of a suitable commercial simulator, a homemade task trainer was constructed. This study aimed to evaluate the feasibility of an EL simulation training course among surgical residents using this low cost task trainer. Methods: To enable simulation training for massive abdominal bleeding with subsequent EL and aortic clamping, a multiprofessional team developed an EL task trainer. A structured evaluation of the trainer and its applicability was performed by external consultants, who tested the trainer themselves. Instructions for constructing the trainer were created and costs were calculated. During the EL simulation course targeted for surgical trainees early in their careers, 34 participants familiarised themselves with EL. Their experiences of the feasibility of the course and increase in self assessed clinical competence in managing the situation were studied using a questionnaire. In a subgroup of trainees, the simulation was compared with a real life EL subsequent to the course. Results: Participants found that the trainer was fit for its purpose (mean score, 4.7 out of 5). Their self assessed clinical competence increased in several domains: EL as a procedure (p < 0.01), handling of intra-abdominal tissues and organs during EL (p = 0.008), and emergency procedures in intra-abdominal haemorrhage (p < 0.001). The cost for the body of the trainer was €108 and there was an additional €42 for the disposables for one training scenario. Conclusion: A low cost task trainer with pulsatile flow enabling surgical residents to rehearse EL with aortic clamping can be constructed from commonly available materials. Preliminary experience of its feasibility and effects on learning in a simulation training course have been positive.

Abstract Introduction Currently, operative reports are narrative and often handwritten, making interpretation difficult and potentially omitting key steps of the procedure. This study undertook a systematic review to determine the current availability of synoptic operative reporting and develop a synoptic operative record template for emergency laparotomy (EL). Methods A PROSPERO registered study from January 1st, 2012, to December 31st, 2022, was conducted using PubMed, Scopus, and Web of Science databases in February 2023. Keywords: emergency laparotomy AND operation notes OR operative notes OR documentation OR report OR pro forma OR narrative OR synoptic OR digital OR audio-visual. Studies on paediatric or pregnant patients, systematic reviews, meta-analyses, case reports, editorial comments, and letters were excluded. A synoptic operative record was designed to include key standards in the documentation, as suggested by the Colleges of Surgeons. Results The literature search yielded 4687 articles, and no relevant published articles were found. A detailed synoptic template was developed, which included 111 fields related to patient demographics, operative findings, interventions, and documentation of key variables associated with patient outcomes. 11 were text boxes, two were related to digital audio-visual uploads, and three facilitated the digital scoring/grading of findings. Conclusion This systematic review identified a limited number of publications reporting synoptic operative reporting, and none related to emergency laparotomy. This novel operative template provides a platform for clear documentation of the surgery performed during emergency laparotomy, potentially facilitating data analysis, resident training, and research, in turn leading to a better understanding of patient outcomes.

Paraovarian cysts are extremely rare and represent approximately 10% of adnexal masses. They are found commonly in women of reproductive age group and arise from the mesothelium. Paraovarian cyst is an entity which is rarely diagnosed preoperatively and often remains undiagnosed and missed out even by radiologists. Most often they remain asymptomatic but when large in size may present with complications such as torsion, hemorrhage, and infection. Isolated torsion of paraovarian cyst is extremely rare. Its diagnosis is often missed out leading to complications.

Tilahun Deresse,1 Esubalew Tesfahun,2 Zenebe Abebe Gebreegziabher,2 Mandante Bogale,3 Dawit Alemayehu,3 Megbar Dessalegn,3 Tewodros Kifleyohans,1 George Eskandar4 1Department of Surgery, Debre Berhan University, Debre Berhan, Ethiopia; 2Department of Public Health, Debre Berhan University, Debre Berhan, Ethiopia; 3Department of Surgery, Debre Markos University, Debre Markos, Ethiopia; 4Department of Surgery, Glan Clwyd Hospital, Rhyl, UKCorrespondence: Tilahun Deresse, Department of Surgery, Debre Berhan University, Debre Berhan, Ethiopia, Email tmaed83@gmail.comBackground: Acute sigmoid volvulus is a surgical emergency with closed-loop obstruction of the colon that often requires emergency laparotomy, which is associated with a multitude of post-operative complications. Although sigmoid volvulus is the main cause of intestinal obstruction in Ethiopia, local studies of its management outcomes are limited.Objective: To assess the magnitude and predictors of adverse perioperative outcomes of emergency laparotomy for acute sigmoid volvulus in the Debre Markos Comprehensive Specialized Hospital (DMCSH), Amhara region, Ethiopia in 2023.Methods: This was a retrospective follow-up study. Descriptive statistics were used to measure perioperative outcomes and other study variables. Bivariable and multivariable logistic regression models were used to identify the predictors of adverse surgical outcomes. Associations were considered significant at p < 0.05 (95% confidence interval).Results: In total, 170 study participants were enrolled, with a response rate of 91.4%. Forty-nine patients (28.8%) developed perioperative adverse outcomes. Pneumonia (29 patients, 28.1%), surgical site infection (19 patients, 18.4%), and wound dehiscence (10 patients, 9.7%) were the most common complications. Pre-operative shock [AOR: 3.87 (95% CI: (1.22, 12.28))], pus or fecal matter contamination of the peritoneum [AOR: 4.43 (95% CI: (1.35, 14.47)], and a higher American Society of Anesthesiologists (ASA) score [AOR: 2.37 (95% CI: (1.05, 5.34))] were identified as predictors of perioperative adverse events.Conclusion: The perioperative adverse outcomes in this study were higher than those reported in Ethiopian national and global reports following emergency laparotomies. Hypotension at presentation, pus and/or fecal matter contamination of the peritoneum, and higher ASA scores are strong predictors of increased perioperative adverse outcomes. Therefore, healthcare providers and institutions involved in the delivery of emergency surgical care should emphasize the importance of early surgical intervention, adequate resuscitation, and patient monitoring to improve perioperative outcomes.Keywords: sigmoid volvulus, perioperative outcome, emergency laparotomy, Ethiopia

Abstract Background and aims The Portsmouth-Physiological and Operative Severity Score for the enumeration of Mortality and Morbidity (P-POSSUM) is one of the scores that is used most frequently for determining the likelihood of mortality in patients undergoing emergency laparotomy. National Emergency Laparotomy Audit (NELA) presents a novel and validated score. Therefore, we aimed to compare the performance of the NELA and P-POSSUM mortality risk scores in predicting 30-day and 90-day mortality in patients undergoing emergency laparotomy. Methods Between August 2020 and October 2022, this cohort study was undertaken at Menoufia University Hospital. We compared the P-POSSUM, preoperative NELA, and postoperative NELA scores in patients undergoing emergency laparotomy. All variables needed to calculate the used scores were collected. The outcomes included the death rates at 30 and 90 days. By calculating the area under the curve (AUC) for every mortality instrument, the discrimination of the various methods was evaluated and compared. Results Data from 670 patients were included. The observed risk of 30-day and 90-day mortality was 10.3% (69/670) and 13.13% (88/670), respectively. Concerning 30-day mortality, the AUC was 0.774 for the preoperative NELA score, 0.763 for the preoperative P-POSSUM score, and 0.780 for the postoperative NELA score. Regarding 90-day mortality, the AUCs for the preoperative NELA score, preoperative P-POSSUM score, and postoperative NELA score were 0.649 (0.581–0.717), 0.782 (0.737–0.828), and 0.663 (0.608–0.718), respectively. There was noticeable difference in the three models' capacity for discrimination, according to pairwise comparisons. Conclusions The probability of 30-day and 90-day death across the entire population was underestimated by the NELA and P-POSSUM scores. There was discernible difference in predictive performance between the two scores.

Operative mortality is an important and objective measure of outcome. Monitoring of outcome is an increasingly important part of the governance of surgical activity. Both the purchasers of health care and individual patients value information concerning mortality and morbidity rates of surgical procedures. Data was collected prospectively on a proforma prepared for the study from the patients undergoing emergency laparotomy. All such patients would have their physiological score recorded on admission. An operative severity score was calculated based on findings recorded by the operating surgeon on the proforma. There were 75 (50%) patients with complications observed during hospital stay. The major ones being chest infections (41 patients, 27.33%), wound infections (37 patients, 24.66%), post operative fever (42 patients, 28.00%) wound dehiscence (31 patients, 20.66%), septicemia (14 patients, 9.33%) and anastomotic leak producing faecal fistula in (14 patients, 9.33%). [ABSTRACT FROM AUTHOR]

Aim: The medical management of inflammatory bowel disease (IBD) is rapidly progressing; however, many patients with the disease still require surgery. Often this is done as an emergency. Initiatives such as the National Emergency Laparotomy Audit have shown how evidence‐based emergency surgery improves outcomes for the patient. The aim of this scoping review is to describe the current evidence base on risk stratification in emergency abdominal surgery for IBD. Methods: A literature search, abstract and full paper screening resulted in 17 articles representing 63 472 patients from seven countries. Results: It is likely that age, the American Society of Anesthesiologists grade, comorbidity and organ dysfunction play a similar role in risk stratification in IBD patients as in other emergency abdominal surgery cohorts. However, the reporting of what is considered an IBD emergency is variable. Six studies include clear definitions of emergency in our study. The range of what is considered an emergency is within 12 h of admission to any time within an unplanned admission. Conclusion: To have data driven, evidence‐based emergency surgical practice in IBD we need consistency of reporting, including the definitions of emergency and urgency. Core descriptor sets in IBD would be valuable. [ABSTRACT FROM AUTHOR]

Introduction: Currently, operative reports are narrative and often handwritten, making interpretation difficult and potentially omitting key steps of the procedure. This study undertook a systematic review to determine the current availability of synoptic operative reporting and develop a synoptic operative record template for emergency laparotomy (EL). Methods: A PROSPERO registered study from January 1st, 2012, to December 31st, 2022, was conducted using PubMed, Scopus, and Web of Science databases in February 2023. Keywords: emergency laparotomy AND operation notes OR operative notes OR documentation OR report OR pro forma OR narrative OR synoptic OR digital OR audio-visual. Studies on paediatric or pregnant patients, systematic reviews, meta-analyses, case reports, editorial comments, and letters were excluded. A synoptic operative record was designed to include key standards in the documentation, as suggested by the Colleges of Surgeons. Results: The literature search yielded 4687 articles, and no relevant published articles were found. A detailed synoptic template was developed, which included 111 fields related to patient demographics, operative findings, interventions, and documentation of key variables associated with patient outcomes. 11 were text boxes, two were related to digital audio-visual uploads, and three facilitated the digital scoring/grading of findings. Conclusion: This systematic review identified a limited number of publications reporting synoptic operative reporting, and none related to emergency laparotomy. This novel operative template provides a platform for clear documentation of the surgery performed during emergency laparotomy, potentially facilitating data analysis, resident training, and research, in turn leading to a better understanding of patient outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Surgical site infection (SSI) is a common complication following emergency laparotomy, particularly in cases with higher contamination levels. These patients are at an increased risk of surgical site infection and delayed wound healing. To reduce the incidence of infection, negative suction drains are often used in the subcutaneous space to evacuate infected content and collect seroma, thereby improving wound healing. This study aims to observe the role of subcutaneous drains in reducing SSI in emergency laparotomies and compare the outcomes of subcutaneous negative pressure closure (using Romo-vac Drain) versus simple skin closure for midline skin incisions. The objective is to identify the optimal method for managing laparotomy wounds between subcutaneous negative pressure closure and simple skin closure. By comparing SSI rates and duration of hospital stay, we aim to determine the most effective approach for these patients. Methods: A longitudinal study was conducted involving 50 patients who met the inclusion and exclusion criteria. Twenty-five patients had a subcutaneous negative pressure drain placed, while the remaining 25 patients underwent simple skin closure without drain placement. SSI infections were graded using the Southampton wound grading system during the post-operative period. Results: The incidence of SSI and the mean duration of hospital stay were found to be significantly lower in patients with subcutaneous negative pressure drain (12% and 7 days, respectively) compared to those without drain (88% and 10.76 days). All measured parameters showed statistically significant differences. Conclusions: The placement of subcutaneous negative pressure drain significantly reduces the occurrence of post-operative surgical site infections and duration of hospital stay following emergency exploratory laparotomy for acute abdomen cases. This approach promotes improved wound healing, faster recovery, and decreased patient morbidity. Furthermore, it helps alleviate the financial burden by reducing hospital stay duration and facilitating early discharge. [ABSTRACT FROM AUTHOR]

Abstract Background Emergency laparotomy (EmLAP) is one of the commonest emergency operations performed in the United Kingdom (approximately 30, 000 laparotomies annually). These potentially high-risk procedures can be life changing with frail patients and/ or older adults (≥ 65 years) having the poorest outcomes, including mortality. There is no gold standard of frailty assessment and no clinical chemical biomarkers existing in practice. Early detection of subclinical changes or deficits at the molecular level are essential in improving our understanding of the biology of frailty and ultimately improving patient outcomes. This study aims primarily to compare preoperative frailty markers, including a blood-based biomarker panel, in their ability to predict 30 and 90-day mortality post-EmLAP. The secondary aim is to analyse the influence of perioperative frailty on morbidity and quality of life post-EmLAP. Methods A prospective single centred observational study will be conducted on 150 patients ≥ 40 years of age that undergo EmLAP. Patients will be included according to the established NELA (National Emergency Laparotomy Audit) criteria. The variables collected include demographics, co-morbidities, polypharmacy, place of residence, indication and type of surgery (as per NELA criteria) and prognostic NELA score. Frailty will be assessed using: a blood sample for ultra-high performance liquid chromatography mass spectrometry analysis; preoperative CT abdomen pelvis (sarcopenia) and Rockwood Clinical Frailty Scale (CFS). Patients will be followed up for 90 days. Variables collected include blood samples (at post operative day 1, 7, 30 and 90), place of residence on discharge, morbidity, mortality and quality of life (EQ-5D-5 L). The frailty markers will be compared between groups of frail (CFS ≥ 4) and non-frail using statistical methods such as regression model and adjusted for appropriate confounding factors. Discussion This study hypothesises that frailty level changes following EmLAP in frail and non- frail patients, irrespective of age. We propose that non- frail patients will have better survival rates and report better quality of life compared to the frail. By studying the changes in metabolites/ biomarkers in these patients and correlate them to frailty status pre-surgery, this highly novel approach will develop new knowledge of frailty and define a new area of clinical biomolecular research. Trial registration ClinicalTrials.gov: NCT05416047. Registered on 13/06/2022 (retrospectively registered).

Background: Emergency laparotomy (EL) is associated with high mortality rates and is performed on a heterogenous patient population. Pre-operative risk assessment is one tool which can assist with EL patient care. We aimed to characterise rates of pre-operative risk assessment for EL patients in South Australia. Methods: A retrospective audit of all patients undergoing EL over one year in six participating hospitals in South Australia was undertaken. Patient demographics, operation details, risk assessments (e.g. NELA, POSSUM, ACS-NSQIP) and outcomes were recorded. Results: 422 ELs were audited. Preoperative risk assessments were recorded for 42 (10 %) operations. The 30-day mortality rate was 9 %. There was no difference in mortality rates for patients with or without a risk assessment documented. Hospital participation in the Australia and New Zealand Emergency Laparotomy Audit (ANZELA) was associated with increased rates of risk assessment. Increasing patient age and then presence of certain comorbidities were also associated with increased rates of risk assessment. Conclusions: This audit shows poor uptake of recommendations for preoperative risk assessment in EL patients in South Australia. Comparable mortality rates to previously published Australian and international data are demonstrated. Factors associated with increased risk assessment rates are identified and are relevant to future quality improvement activities.

Summary: The probability of death after emergency laparotomy varies greatly between patients. Accurate pre‐operative risk prediction is fundamental to planning care and improving outcomes. We aimed to develop a model limited to a few pre‐operative factors that performed well irrespective of surgical indication: obstruction; sepsis; ischaemia; bleeding; and other. We derived a model with data from the National Emergency Laparotomy Audit for patients who had emergency laparotomy between December 2016 and November 2018. We tested the model on patients who underwent emergency laparotomy between December 2018 and November 2019. There were 4077/40,816 (10%) deaths 30 days after surgery in the derivation cohort. The final model had 13 pre‐operative variables: surgical indication; age; blood pressure; heart rate; respiratory history; urgency; biochemical markers; anticipated malignancy; anticipated peritoneal soiling; and ASA physical status. The predicted mortality probability deciles ranged from 0.1% to 47%. There were 1888/11,187 deaths in the test cohort. The scaled Brier score, integrated calibration index and concordance for the model were 20%, 0.006 and 0.86, respectively. Model metrics were similar for the five surgical indications. In conclusion, we think that this prognostic model is suitable to support decision‐making before emergency laparotomy as well as for risk adjustment for comparing organisations. [ABSTRACT FROM AUTHOR]

Background: Whilst there has been significant improvement in mortality outcomes after emergency laparotomy, there is little information on longer term outcomes in the year after discharge. The main aim of the study was to assess the impact that an emergency laparotomy has on patients' and employment and health status 1 year after surgery. Methods: This study was a questionnaire study conducted in a single centre district general hospital of patients who had undergone an emergency laparotomy between October 2015 and December 2016. Patients were included according to the National Emergency Laparotomy Audit criteria. At screening, patients who were alive at 1 year and had the capacity to consent were approached between January and December 2017. Patients underwent a researcher-led telephone interview using a semi-structured questionnaire to assess the impact of emergency laparotomy on overall, general and physical health (Glasgow Benefit Inventory) as well as employment status. The symptoms that patients experienced and their impact were also recorded. Results: Forty-two patients responded to and completed the questionnaire. Just over one-third of patients experienced a deterioration in their general or physical health and 21% of patients experienced a change in employment. Factors which significantly impacted on health status were stoma issues, postoperative morbidity and a change in employment (p < 0.05). The main symptoms which patients identified as being troublesome were altered bowel habit and stoma issues with a resultant social and psychological impact. Conclusions: One-third of patients experienced a deterioration in their psychosocial and physical health status as well as a change in employment during the first-year postsurgery. Larger research studies are required to define the impact of emergency laparotomy on patients in the longer term and more research is needed to improve perioperative rehabilitation in the postoperative period to ensure optimal functional gain after technically successful surgery. [ABSTRACT FROM AUTHOR]

Background and aims: The Portsmouth-Physiological and Operative Severity Score for the enumeration of Mortality and Morbidity (P-POSSUM) is one of the scores that is used most frequently for determining the likelihood of mortality in patients undergoing emergency laparotomy. National Emergency Laparotomy Audit (NELA) presents a novel and validated score. Therefore, we aimed to compare the performance of the NELA and P-POSSUM mortality risk scores in predicting 30-day and 90-day mortality in patients undergoing emergency laparotomy. Methods: Between August 2020 and October 2022, this cohort study was undertaken at Menoufia University Hospital. We compared the P-POSSUM, preoperative NELA, and postoperative NELA scores in patients undergoing emergency laparotomy. All variables needed to calculate the used scores were collected. The outcomes included the death rates at 30 and 90 days. By calculating the area under the curve (AUC) for every mortality instrument, the discrimination of the various methods was evaluated and compared. Results: Data from 670 patients were included. The observed risk of 30-day and 90-day mortality was 10.3% (69/670) and 13.13% (88/670), respectively. Concerning 30-day mortality, the AUC was 0.774 for the preoperative NELA score, 0.763 for the preoperative P-POSSUM score, and 0.780 for the postoperative NELA score. Regarding 90-day mortality, the AUCs for the preoperative NELA score, preoperative P-POSSUM score, and postoperative NELA score were 0.649 (0.581–0.717), 0.782 (0.737–0.828), and 0.663 (0.608–0.718), respectively. There was noticeable difference in the three models' capacity for discrimination, according to pairwise comparisons. Conclusions: The probability of 30-day and 90-day death across the entire population was underestimated by the NELA and P-POSSUM scores. There was discernible difference in predictive performance between the two scores. [ABSTRACT FROM AUTHOR]

Aim: Emergency laparotomy and laparoscopy (EmLap) are amongst the commonest surgical procedures, with high prevalence of sepsis and hence poorer outcomes. However, whether time taken to receive care influences outcomes in patients requiring antibiotics for suspected infection remains largely unexplored. The aim of this work was to determine whether (1) time to care contributes to outcome differences between patients with and without suspected infection and (2) its impact on outcomes only amongst those with suspected infection. Method: Clinical information was retrospectively obtained from the 2017–2018 Emergency Laparotomy and Laparoscopic Scottish Audit (ELLSA). Time to care referred to six temporal variables describing radiological investigation, anaesthetic triage and surgical management. Outcome measures [mortality, readmission, hospital death, postoperative destination and length of stay (LoS)] were compared using adjusted and unadjusted regression analyses to determine whether the outcome differences could be explained by faster or slower time to care. Results: Amongst 2243 EmLap patients [median age 65 years (interquartile range 51–75 years), 51.1% female], 892 (39.77%) received antibiotics for suspected infection. Although patients with suspected infection had faster time to care (all p ≤ 0.001) and worse outcomes compared with those who did not, outcome differences were not statistically significant when accounted for time (all p > 0.050). Amongst those who received antibiotics, faster time to care was also associated with decreased risk of postoperative intensive care unit (ICU) stay and shorter LoS (all p < 0.050). Conclusion: Worse outcomes associated with infection in EmLap patients were attenuated by faster time to care, which additionally reduced the LoS and ICU stay risk amongst those with suspected infection. [ABSTRACT FROM AUTHOR]

Background: Quantitative futility is an appraisal of the risk of failure of a treatment. For those who do not survive, a laparotomy has provided negligible therapeutic benefit and may represent a missed opportunity for palliation. The aim of this study was to define a timeframe for quantitative futility in emergency laparotomy and investigate predictors of futility using the National Emergency Laparotomy Audit (NELA) database. Methods: A two-stage methodology was used; stage one defined a timeframe for futility using an online survey and steering group discussion; stage two applied this definition to patients enrolled in NELA December 2013–December 2020 for analysis. Futility was defined as all-cause mortality within 3 days of emergency laparotomy. Baseline characteristics of this group were compared to all others. Multilevel logistic regression was carried out with potentially clinically important predictors defined a priori. Results: Quantitative futility occurred in 4% of patients (7442/180,987). Median age was 74 years (range 65–81 years). Median NELA risk score was 32.4% vs. 3.8% in the surviving cohort (p < 0.001). Early mortality patients more frequently presented with sepsis (p < 0.001). Significant predictors of futility included age, arterial lactate and cardiorespiratory co-morbidity. Frailty was associated with a 38% increased risk of early mortality (95% CI 1.22–1.55). Surgery for intestinal ischaemia was associated with a two times greater chance of futile surgery (OR 2.67; 95% CI 2.50–2.85). Conclusions: Quantitative futility after emergency laparotomy is associated with quantifiable risk factors available to decision-makers preoperatively. These findings should be incorporated qualitatively by the multidisciplinary team into shared decision-making discussions with extremely high-risk patients. [ABSTRACT FROM AUTHOR]