Predictors of mortality in patients undergoing emergency abdominal surgery: a prospective study

Maurice, Karim K.; Hamour, Dina; Mostafa, Mohamed S.; Khatta, Mohamed; Aiad, George; Abdelaziz, Ahmed

doi:10.4103/ejs.ejs_322_22

Predictors of mortality in patients undergoing emergency abdominal surgery: a prospective study

Authors

Abstract

Background
Emergency surgery, compared with planned surgery, is strongly associated with increased risks of adverse postoperative outcomes owing to the short time available for diagnostic procedures, patient optimization, and surgical intervention in patients presenting with physiological derangement.
Patients and methods
A prospective cohort study was performed that included 118 patients. They were divided into two groups according to the outcome: group M and group S. A number of predictors were stratified into preoperative, intraoperative, and postoperative predictors and correlated with mortality.
Results
The most frequently encountered intraoperative finding was viscus perforation (27.1%), followed by appendicitis (25.4%). There was a mortality incidence of 31.35%. Septic shock was the most common cause of death (64.7%). Mortality was strongly correlated with a number of predictors, including age, BMI, diabetes, hypertension and liver disease, systolic blood pressure on presentation and after patient optimization, respiratory rate, Glassgo coma scale (GCS), urine output, acid–base derangement, presence of multiorgan dysfunction especially renal and cardiovascular, and coronavirus disease infection. Intraoperative and postoperative predictors included severe hypotension after induction, urine output, contamination, bleeding and need for blood transfusion, need for ICU admission, need for hemodynamic support/mechanical ventilation, need for dialysis, contractility less than 40%, postoperative lactate levels, and development of complications. Duration of symptoms, history of surgery within 30 days, length of trial of conservative management if indicated, operative time, and presence of malignancy were not shown to be significant predictors.
Conclusion
Executing the study has assisted in highlighting care processes that need improvement and that could be focused upon. Furthermore, it proved to be a reliable tool to be used for auditing purposes that allows risk adjusted measurement of the quality of care hence providing standardization of medical care.

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