scholarly journals Scoring Systems May be Effective in Predicting Mortality Associated with Palliative Emergency Gastrointestinal Surgery: A Retrospective Observational Study

2021 ◽  
Author(s):  
M. Laitamäki ◽  
I. Alamylläri ◽  
M. Kalliomäki ◽  
J. Laukkarinen ◽  
M. Ukkonen ◽  
...  
Keyword(s):  
Patient Population ◽  
Operative Mortality ◽  
Gastrointestinal Surgery ◽  
Scoring Systems ◽  
Morbidity And Mortality ◽  
Emergency Laparotomy ◽  
Improvement Program ◽  
Mortality And Morbidity ◽  
Asa Score ◽  
Acs Nsqip

Abstract Background Palliative emergency gastrointestinal surgery is associated with significant morbidity and mortality and weighing up the benefits and harms during the decision-making may be challenging. There are very few studies on surgery in palliative patient population. The aim of this retrospective study was to evaluate morbidity and mortality after palliative emergency gastrointestinal surgery and the usability of scoring systems in predicting the outcome. Methods Consecutive adult patients undergoing palliative emergency surgery at a tertiary hospital during the period 2015 to 2016 were included. Pre- and post-operative functional status, morbidity and mortality of patients were assessed. The predictive value of the American Society of Anesthesiologists (ASA) classification, the American College of Surgeons National Surgical Quality Improvement Program Surgical Risk Calculator (ACS NSQIP SRC) and Palliative index (PI) in estimating morbidity and mortality were determined. Results A total of 93 patients (age 69 [28–92] years, 51% female) were included. Typical indications for surgery were bowel obstruction (52%) and securing food intake (30%). Pre-operatively two patients (2.2%) were totally dependent in daily activities, while post-operatively the respective share was 34% at discharge from hospital. The incidence of post-operative complications was 37% and 14% died during the hospital stay. One-, three-month and one-year mortality rates were 41%, 63% and 87%, respectively. While ASA score, PI score and ACS NSQIP did not predict post-operative morbidity, both ASA score and ACS NSQIP SRC predicted post-operative mortality. Conclusions Palliative emergency laparotomy is associated with significant post-operative mortality and morbidity. Scorings, such as ASA score and ACS NSQIP SRC predict mortality in this patient population.

scholarly journals 812 Mortality Risk prediction in Emergency Laparotomy (ORIEL) Study Outcomes at Wythenshawe Hospital

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
C Carey ◽  
B Pittam ◽  
S Mobarak ◽  
R Varley ◽  
J Kingston ◽  
...  
Keyword(s):  
High Risk ◽  
Operative Mortality ◽  
Scoring Systems ◽  
Mortality Rates ◽  
National Study ◽  
Emergency Laparotomy ◽  
Mortality And Morbidity ◽  
Mortality Risks ◽  
Acs Nsqip ◽  
Risk Patients

Abstract Aim Emergency laparotomy is a high-risk procedure with significant morbidity and mortality. ORIEL is a multi-centre national study aiming to compare the 30-day mortality predictions generated by NELA, P-POSSUM, ACS-NSQIP and SORT risk calculators with observed 30-day mortality rates in patients undergoing emergency laparotomies. We present the data collected from Wythenshawe hospital. Method Data were collected retrospectively on adult patients undergoing an emergency laparotomy between 01/12/2017 to 30/11/2019 at Wythenshawe hospital from the online NELA database. The median pre-operative mortality risks were calculated using the four risk calculators for all patients. Mortality and morbidity were compared with data reported in the Sixth NELA report. Results The median predicted pre-operative mortality (IQR) for all patients studied using NELA, P-POSSUM, ACS-NSQIP and SORT were: 4.3 (13.0), 5.2 (14.2), 3.4 (8.2) and 2.9 (9.3) respectively. Among patients who were alive 30 days post-operatively, the median predicted mortalities (IQR) were: 3.8 (8.5), 4.8 (11.0), 2.6 (6.9) and 2.8 (7.1) respectively, and among those who died were: 30.8 (18.9), 30.3 (63.4), 16.9 (13.9) and 20.3 (16.2). Compared to the national average, mortality rates at Wythenshawe were lower (9% v 9.3%), the median length of stay in hospital was lower (12 days v 15.4 days) and the percentage of high-risk patients admitted to critical care was higher (93% v 85%). Conclusions Similar values were generated with all the scoring systems among all patients. Wythenshawe hospital reports lower mortality rates and shorter stays in hospital despite operating on higher risk patients (ASA grades 3-5).

EP.FRI.743 Mortality Risk prediction in Emergency Laparotomy (ORIEL) Study Outcomes at Wythenshawe Hospital

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Bradley Pittam ◽  
Charles Carey ◽  
Shahd Mobarak ◽  
Rebecca Varley ◽  
Jennifer Kingston ◽  
...  
Keyword(s):  
High Risk ◽  
Operative Mortality ◽  
Scoring Systems ◽  
Mortality Rates ◽  
National Study ◽  
Emergency Laparotomy ◽  
Mortality And Morbidity ◽  
Mortality Risks ◽  
Acs Nsqip ◽  
Risk Patients

Abstract Aim Emergency laparotomy is a high-risk procedure with significant morbidity and mortality. ORIEL is a multi-centre national study aiming to compare the 30-day mortality predictions generated by NELA, P-POSSUM, ACS-NSQIP and SORT risk calculators with observed 30-day mortality rates in patients undergoing emergency laparotomies. We present the data collected from Wythenshawe hospital. Method Data were collected retrospectively on adult patients undergoing an emergency laparotomy between 01/12/2017 to 30/11/2019 at Wythenshawe hospital from the online NELA database. The median pre-operative mortality risks were calculated using the four risk calculators for all patients. Mortality and morbidity were compared with data reported in the Sixth NELA report. Results The median predicted pre-operative mortality (IQR) for all patients studied using NELA, P-POSSUM, ACS-NSQIP and SORT were: 4.3 (13.0), 5.2 (14.2), 3.4 (8.2) and 2.9 (9.3) respectively. Among patients who were alive 30 days post-operatively, the median predicted mortalities (IQR) were: 3.8 (8.5), 4.8 (11.0), 2.6 (6.9) and 2.8 (7.1) respectively, and among those who died were: 30.8 (18.9), 30.3 (63.4), 16.9 (13.9) and 20.3 (16.2). Compared to the national average, mortality rates at Wythenshawe were lower (9% v 9.3%), the median length of stay in hospital was lower (12 days v 15.4 days) and the percentage of high-risk patients admitted to critical care was higher (93% v 85%). Conclusions Similar values were generated with all the scoring systems among all patients. Wythenshawe hospital reports lower mortality rates and shorter stays in hospital despite operating on higher risk patients (ASA grades 3-5).

scholarly journals P-EGS17 Evaluation of Different Surgical Risk Prediction Models in Predicting Morbidity and Mortality in Emergency Giant Hiatus and Diaphragmatic Hernia Repairs

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Mohamed Alasmar ◽  
Eleanor Moore ◽  
Iona McKechnie ◽  
Ram Chaparala
Keyword(s):  
Risk Prediction ◽  
Diaphragmatic Hernia ◽  
Prediction Models ◽  
Morbidity And Mortality ◽  
Emergency Laparotomy ◽  
Comprehensive Complication Index ◽  
Risk Prediction Models ◽  
Mortality And Morbidity ◽  
Acs Nsqip ◽  
Operative Severity Score

Abstract Background Emergency presentation of giant hiatus and diaphragmatic hernias are associated with significant morbidity and mortality, and predicting perioperative risks can be difficult. There are several preoperative risk evaluation models used commonly in emergency general surgery. Not only can they help clinicians stratify risk, but they can also be valuable tools to outline surgical risks to patients and families. This study aimed to evaluate the suitability of different risk prediction models when predicting morbidity and mortality in emergency giant hiatus and diaphragmatic hernia repairs. Methods This was a retrospective cohort study of all emergency hiatus and diaphragmatic hernia repairs at a tertiary upper gastrointestinal centre from 2010 to 2021. The outcomes were compared to the predicted mortality and morbidity of different risk prediction models. The mortality models SORT (Surgical Outcome Risk Tool), NELA (National Emergency Laparotomy Audit) and ACS-NSQIP (American College of Surgeons National Surgical Quality Improvement Programme) were compared using the area under the curve (AUC).  Morbidity was evaluated by calculating the comprehensive complication index (CCI). CCI was compared to P-POSSUM (Portsmouth – Physiological and Operative Severity Score) and ACS-NSQIP predicted morbidity using Spearman correlation. Results 108 patients were included in the analysis. 49.1% were female, and 50.9% were male. The median age was 69 (IQR 59-78). The 30-day mortality rate was 6.93%. ACS-NSQIP had the highest predictive power for mortality (AUC = 0.845), in comparison to NELA (AUC=0.809) and SORT (AUC = 0.740). Both ACS-NSQIP and P-POSSUM showed moderate correlation to CCI (rho = 0.489, p < 0.001 and 0.446, p < 0.001 respectively). Conclusions ACS-NSQIP is a better predictor of both mortality and morbidity in emergency giant hiatus and diaphragmatic hernia repairs when compared to NELA, P-POSSUM and SORT. ACS-NSQIP may have a role in pre-assessment and consenting of emergency giant hiatus and diaphragmatic hernia repairs. Multi-centre prospective studies could be used to validate these findings.

scholarly journals 61 Impact of Dedicated Geriatrician Involvement on National Emergency Laparotomy Audit Standards and Outcomes

2019 ◽  
Vol 48 (Supplement_3) ◽  
pp. iii1-iii16
Author(s):  
Roisin Coary ◽  
Kath Jenkins ◽  
Emma Mitchell ◽  
Anne Pullyblank ◽  
David Shipway
Keyword(s):  
Older Patients ◽  
Ad Hoc ◽  
Gastrointestinal Surgery ◽  
Emergency Laparotomy ◽  
Published Data ◽  
Mortality And Morbidity ◽  
The United Kingdom ◽  
Service Introduction ◽  
National Emergency ◽  
The Impact

Abstract Background Older patients undergoing emergency laparotomy (EmLap) have high levels of mortality and morbidity. The National Emergency Laparotomy Audit (NELA) in the United Kingdom records processes and outcome measures for patients undergoing EmLap. Recent data shows that geriatrician review is associated with reduced post-surgical mortality (Oliver C.M. et al., British Journal of Anaesthesia 2018). Geriatrician review of all patients aged ≥70 years is a NELA standard. However, the most recent national report shows only 23% compliance, falling short of the target of 80% and consistently the poorest performing standard. Methods In August 2018, we established a dedicated gastrointestinal surgery liaison service to replace ad hoc geriatrician reviews. We evaluated the impact on NELA standard compliance and patient outcomes. Data were extracted from the local NELA database on all patients aged ≥70 years, for the first six months of the service (September to February). These were compared to the same time period in the preceding year prior to service launch. Results Following service introduction, increased numbers of patients aged ≥70 years underwent EmLap: 50 (2018-9) vs 31 (2017-8). Geriatrician review occurred in 86% (n=43) in 2018-9, compared to 16% (n=5) in 2017-8. Inpatient mortality fell from 23% (n=7) in 2017-8 to 14% (n=7) in 2018-9. Discharge to own home rose to 76% (n=38) in 2018-9 from 68% (n=21) in 2017-8. One patient in each cohort was newly discharged to a nursing home. Mean length of stay was 17.9 days in 2018-9 (range 3-75), versus 17.6 in 2017-8 (range 3-94). Conclusion Introduction of a dedicated geriatric surgical liaison service is associated with increased compliance with NELA standards. Despite more emergency laparotomies being performed on older patients, this was associated with improved mortality and rates of home discharge, consistent with published data. Targeted investment in surgical liaison services may therefore be warranted.

Thoracoplasty: Still relevant to current practice

2021 ◽  
pp. 021849232110024
Author(s):  
Rebecca Phillip ◽  
Amber Bettis ◽  
Daniel Davenport ◽  
Sibu Saha
Keyword(s):  
Current Practice ◽  
Average Length ◽  
Muscle Flap ◽  
Outcome Data ◽  
Pleural Space ◽  
Class Iii ◽  
Short Term ◽  
Improvement Program ◽  
Mortality And Morbidity ◽  
Acs Nsqip

Background Management of residual pleural space remains a challenge in the practice of thoracic surgery. Options include thoracotomy with muscle flap/wound vac, Eloesser procedure, or thoracoplasty. We examine current practice and short-term outcomes of thoracoplasty in the American College of Surgeons National Surgery Quality Improvement Program (ACS NSQIP). Methods A retrospective review of thoracoplasty procedures (by CPT® code 32900, 32905, or 32906) in the ACS NSQIP database from the years 2012 to 2017 was performed. The ACS NSQIP prospectively collects perioperative and rigorous 30-day outcome data for patients undergoing major thoracic surgical nationally. Results The dataset contained 131 thoracoplasties in patients with an average age of 48 years (SD 19), average BMI of 26 kg/m2 (SD 5), 48% female, and 21% of minority race. Forty percent of patients were ASA class III and 10% class IV–V. Five percent of the patients had muscle flap in addition to thoracoplasty. Median operative duration was 101 min (interquartile range 61–167) and 8% of patients required blood transfusion. The average length of hospital stay was 6 days (SD 9), and 93% of patients were discharged home. There was one death, and 23% experienced other major morbidity. Thirty-day readmission occurred in 8% of patients and 6% returned to the operating room within 30 days. Four percent of patients experienced respiratory failure, 4% sepsis, and 5% developed pneumonia. Conclusions Short-term outcomes of current thoracoplasty demonstrate low mortality and morbidity. Thoracoplasty should remain in our armamentarium for managing residual pleural space.

scholarly journals Evaluation of the validity of POSSUM and P-POSSUM score in predicting the risk of morbidity and mortality respectively in patients undergoing emergency laparotomy

2020 ◽  
Vol 7 (10) ◽  
pp. 3224
Author(s):  
Vivian Anandith Paul ◽  
Agnigundala Anusha ◽  
Alluru Sarath Chandra
Keyword(s):  
Mortality Rate ◽  
Linear Method ◽  
Morbidity And Mortality ◽  
Emergency Laparotomy ◽  
Medical Sciences ◽  
Mortality And Morbidity ◽  
Possum Score ◽  
Operative Severity Score ◽  
Significant Difference ◽  
Predicted Values

Background: Aim of this study is to examine the efficacy of Physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM) and Portsmouth predictor modification (P-POSSUM) equations in predicting morbidity and mortality in patients undergoing emergency laparotomy, to study the morbidity and mortality patterns in patients undergoing emergency laparotomy at Malla Reddy Institute of Medical Sciences, Hyderabad. Methods: The study was conducted for a period of 2 years from February 2018 to February 2020. 100 Patients undergoing emergency laparotomy were studied in the Department of General surgery MRIMS, Hyderabad. POSSUM and P-POSSUM scores are used to predict mortality and morbidity. The ratio of observed to expected deaths (O:E ratio) was calculated for each analysis. Results: The study included total 100 patients, 83 men and 17 women. Observed mortality rate was compared to mortality rate with POSSUM, the O:E ratio was 0.62, and there was no significant difference between the observed and predicted values (χ²=10.79, 9 degree of freedom (df) p=0.148). Observed morbidity rates were compared to morbidity rates predicted by POSSUM, there was no significant difference between the observed and predicted values (χ²=9.89, 9 df, p=0.195) and the overall O:E ratio was 0.91. P-POSSUM predicted mortality equally well when the linear method of analysis was used, with an O:E ratio of 0.65 and no significant difference between the observed and predicted values (χ²= 5.33, 9 df, p= 0.617).Conclusion: POSSUM and P-POSSUM scoring is an accurate predictor of mortality and morbidity following emergency laparotomy and is a valid means of assessing adequacy of care provided to the patient. 

scholarly journals Clinical study of relaparotomy after emergency general surgery in a tertiary center of central India: a retrospective study

2020 ◽  
Vol 7 (8) ◽  
pp. 2490
Author(s):  
Archana Shukla ◽  
Ramashankar Gupta ◽  
Prateek Malpani
Keyword(s):  
General Surgery ◽  
Rare Complication ◽  
Morbidity And Mortality ◽  
Emergency Laparotomy ◽  
Anastomotic Site ◽  
Emergency General Surgery ◽  
Case Record ◽  
Mortality And Morbidity ◽  
Initial Surgery ◽  
Tertiary Center

Background: Relaparotomy after emergency surgery is a catastrophic situation associated with significant morbidity and mortality. Incidence is highly variable depending not only on hospital set up but also on the patient’s characteristics as well as on the initial surgery and postoperative care given. This study was thus, planned to identify the indications, procedure, risk factors and outcomes of relaparotomy so that timely intervention can lower incidence and morbidity.Methods: This was a retrospective cohort study conducted in department of general surgery, Gandhi Medical College and associated Hamidia Hospital from January 2018 to December 2019. All patients irrespective of age and sex, who have undergone emergency re-exploration of the abdomen during the period of hospitalization after the first operation and discharge of patients. Data were recorded in pre-validated case record form.Results: 32 cases of relaparotomy were identified. All patients had emergency laparotomy as primary surgery. Majority of patients required relaparotomy for anastomotic site leak in 16 cases (50%) followed by intestinal obstruction in 10 cases (31%), hemorrhage in 4 cases (16%) while the least cause being intra-abdominal sepsis in 2 cases (6.2%). Relaparotomy was associated with increased mortality and morbidity. Out of 32 patients, 4 (12.5%) patients died.Conclusions: Relaparotomy is a rare complication and a lifesaving procedure for patients. Calculative experience guided decision on relaparotomy can decrease the incidence of morbidity and mortality associated with the procedure.

Adult Palatopharyngoplasty: Trends in Morbidity and Mortality from the NSQIP Database

2020 ◽  
Vol 130 (1) ◽  
pp. 5-11
Author(s):  
Christopher Gates ◽  
Jad Ramadan ◽  
Steven Coutras ◽  
Michele Carr
Keyword(s):  
Low Frequency ◽  
Morbidity And Mortality ◽  
Myocardial Infarctions ◽  
Improvement Program ◽  
Surgical Quality ◽  
Significance Level ◽  
Mortality And Morbidity ◽  
Predictive Variables ◽  
American College Of Surgeons ◽  
Associated Variables

Objectives: Describe the postop morbidity of adults undergoing palatopharyngoplasty (PPP). Method: Adults who underwent PPP were studied using ACS-NSQIP (American College of Surgeons National Surgical Quality Improvement Program) database (2016-2017) via CPT code 42145. Analyzed outcomes included length of stay (LOS), readmission, reoperation, and postop complications. Predictive variables were age, gender, BMI, comorbidities. Results: A total of 1081 patients (73.7% male, mean age 42.0 years, range 18-79 years) were included. 95 (8.8%) were diabetic, 183 (16.9%) were smokers, 30 (2.8%) had preoperative dyspnea. 328 (30.3%) took medicine for hypertension. Concurrent procedures occurred in 646 (59.76%), 357 (33.02%) had nasal procedures, 320 (29.60%) had tonsil procedures, 66 (6.11%) had tongue procedures. Within 30 days postop, there were two (0.19%) mortalities. Complications included six wound infections, two dehiscences, four with pneumonia, two pulmonary embolisms, three myocardial infarctions, one DVT, three sepsis, one UTI, one who required CPR, and two who were ventilated for >48 hours. Five required reintubation. A total of 41 (3.79%) returned to OR for a related reason, at least 27 (65.90%) for bleeding. LOS ranged from 0 to 15 days, median 1 day. Overall 38 (3.52%) were readmitted for a related reason, 12 (31.58%) for bleeding and three (7.89%) for pain. Using a significance level of 0.002 (Bonferroni correction), LOS varied with presence of any concurrent procedure, BMI, and estimated probability of mortality and morbidity indices; readmission and reoperation had no significantly associated variables. Conclusion: PPP is associated with low frequency but significant morbidity and mortality.

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