Outcomes for operative and nonoperative management for gastrointestinal emergencies

BACKGROUND: Gastrointestinal (GI) conditions requiring emergency laparotomy are common, but it has been increasingly recognised that many patients never undergo surgery. This study used electronic healthcare records (EHRs) to provide an insight into the number of patients admitted with GI emergencies at a population level. In this paper we present condition specific outcomes for nine common diagnoses that may require emergency laparotomy. METHODS: A single-centre retrospective cohort study was conducted at a tertiary public hospital (1 December 2013-31 January 2020). Patients were identified using diagnosis codes for GI emergencies, based on the inclusion criteria for the National Emergency Laparotomy Audit. Relevant data were extracted from EHRs. RESULTS: Approximately half of the 2,274 patients included received non-operative management, and its use was notably high for intestinal ischaemia (72.3%) and complex diverticulitis (60.5%). Perforated peptic ulcers (92.9%), volvulus (70.4%) and adhesional small bowel obstruction (61.9%) were most likely to require surgery. Emergency laparoscopy rates were high (56.4%) and rate of conversion relatively low (29.5%). Median length of stay was shorter for nonoperative management than for surgery (5.8 days versus 10-16 days). Also, 30-day mortality for nonoperative management was much higher than for surgery (24.7% versus 12.5%). Patients classified as clinically unstable using vital signs/routine blood tests had a much higher 30-day mortality rate than those who were stable (38.7% versus 5.8%), notably in the nonoperative group (46.6% versus 6.4%). CONCLUSIONS: A higher proportion of GI emergencies are treated with nonoperative management than might be expected. However, mortality rates for nonoperative management were higher than for surgery, particularly in clinically unstable patients.