The emergency laparotomy protocol: a retrospective cohort study of outcomes after implementing a perioperative protocol for emergency laparotomies

Abstract Introduction Emergency laparotomy (EL) is associated with high mortality. A perioperative protocol for EL based on ERAS guidelines was introduced at our institution in 2019. Prior to the implementation, 30-day mortality was 12%. We describe the demography, surgical indications, and outcomes following its introduction. Method Retrospective cohort study of all patients undergoing EL at St Görans’ Sjukhus 2019-2022. Mortality was recorded over 30, 90, and 180 days. Serious complications (Clavien-Dindo class ≥ IIIb) were recorded over 30 days. Result 682 patients were included. Median age was 72 years. 79.6% (n=543) lived independently at home. ASA III-V comprised 56.7% (n=387) of patients. The most common EL indications were bowel obstruction (64.2%; n=438) and bowel perforation (19.6%; n=134). Hospital length of stay was 8 (IQR 7) days. Mortality at 30 days was 6.89% (n=47), 90 days 11.0% (n=75), and 180 days 12.8% (n=87). 81 patients (11.9%) had a serious nonfatal complication. Mortality increased with age, and was 23.9% for patients ≥ 80yrs and 4.4% <65yrs (p<0.001). Predictors for mortality were patient admission not from home (p = 0.043), presence of disseminated cancer (p < 0.001), and presence of septic shock (p = 0.003) or SIRS (p = 0.017). Discussion The results suggest that patients undergoing EL are elderly and at higher risk of complications and mortality. Standardised perioperative management could potentially reduce mortality rates. Focusing on frailty and surgical-geriatric liaison care for these patients might reduce in-hospital LOS and improve postoperative outcomes. The study did not assess individual care bundle components.