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What Pathologies Present Acutely Requiring An Emergency Laparotomy?

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Introduction

The National Emergency Laparotomy Audit (NELA) Registry is a comprehensive national registry collating data on patients undergoing emergency laparotomy.

It is used to benchmark performance against set standards to ensure Trusts provided high standard of care to all patients.

Data of all patients admitted to Whipps Cross University Hospital requiring an emergency laparotomy are submitted to the NELA Registry.

We analysed the physiological burden of disease for patients undergoing emergency laparotomy at our high volume teaching hospital located at Whipps Cross University Hospital in London, United Kingdom.

Emergency laparotomies are believed to be on the decrease due to better identification of pathologies, earlier presentation for medical treatment and screening programmes enabling such conditions to be treated electively instead of as an emergency (which is considered to have higher complication and mortality rates).


Methods

We analysed data from the NELA Registry for our hospital between 1/1/2013 and 31/12/2016.

266 patients were submitted to the NELA Registry during this period for whom there was a complete dataset entered within the NELA Registry.

Analysis of all 266 patients undergoing an emergency laparotomy was undertaken We reviewed the data to identify which clinical pathologies precipitated the need for emergency laparotomies.


Results

For an equal gender distribution (male 51%, female 49%) and age range 18-94 (mean 60 years), there were 392 different clinical pathologies recorded in total as having been present at emergency laparotomy (many patients had multiple concomitant pathologies identified).

Earlier versions of the NELA Registry had non-descript data fields but have since been refined to collate more precise data (e.g. type of bowel obstruction [small or large bowel obstruction]).

Bowel obstruction and perforation were frequently occurring pathologies requiring emergency laparotomies, followed by peritonitis and sepsis.

Bowel ischaemia and haemorrhage (either trauma or post- operative bleeding) are the next most frequent causes.

Adhesions, whilst not itemised separately in the Registry, are regular reasons for operative intervention and are listed under other conditions.

The pattern of disease is as expected with the sicker patients (identified by higher ASA score) having a correlation with older age.

However, there are a number of deviations from this with a larger proportion of younger people who are sicker with more co- morbidities.


Conclusions

Despite beliefs that emergency laparotomies are on the decline, NELA Registry data for our high volume university teaching hospital demonstrates a high incidence of clinical conditions presenting acutely requiring hospital admission and emergent laparotomies to treat the high morbidity and mortality that such conditions cause if left untreated.

The emergency conditions which presented to Whipps Cross University Hospital are not those that can generally be managed conservatively or via other less invasive modalities. Part of this reason may be due to the severity and extent of the disease when many patients have a delayed presentation to the hospital.

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