Postoperative morbidity survey, mortality and length of stay following emergency laparotomy

Thirty-day mortality following emergency laparotomy is high, and greater amongst elderly patients. Studies systematically describing peri-operative complications are sparse, and heterogeneous. We used the postoperative morbidity survey to describe the type and frequency of complications, and their relationship with outcomes for 144 patients: 114 <80years old, and 30 80years old. Cumulative postoperative morbidity survey scores and patterns of morbidity were similar (p=0.454); however, 28-day mortality was higher in the elderly (10/30 (33.3%) vs 11/114 (9.6%), p=0.008), and hospital stay was longer (median (IQR [range]) 17 (13-35 [6-62]) days vs 11 (7-21 [2-159])days, p=0.006). Regression analysis indicated that cardiovascular, haematological, renal and wound complications were associated with longer hospital stay, and that cardiovascular complications predicted mortality. The postoperative morbidity survey system enabled structured mapping of the number and type of complications, and their relationship with outcome, following emergency laparotomy. These results indicate that rather than a greater propensity to complications following surgery, it was the failure to tolerate these that increased mortality in the elderly.