Abstract：
Patients who require emergency laparotomy are defined as high risk if their 30-day predicted risk of mortality is ≥ 5%. Despite a large difference in the characteristics of patients with a mortality risk score of between 5% and 50%, these outcomes are aggregated by the National Emergency Laparotomy Audit (NELA). Our aim was to describe the outcomes of the cohort of patients at extreme risk of death, which we defined as having a NELA-predicted 30-day mortality of ≥ 50%. All patients enrolled in the NELA database between December 2012 and 2020 were included. We compared patient characteristics; length of hospital stay; rates of unplanned return to the operating theatre; and 90-day survival in extreme-risk groups (predicted ≥ 50%) and high-risk patients (predicted 5-49%). Of 161,337 patients, 5193 (3.2%) had a predicted mortality of ≥ 50%. When patients were further subdivided, 2437 (47%) had predicted mortality of 50-59% (group 50-59); 1484 (29%) predicted mortality of 60-69% (group 60-69); 840 (16%) predicted mortality of 70-79% (group 70-79); and 423 (8%) predicted mortality of ≥ 80% (group 80+). Extreme-risk patients were significantly more likely to have been admitted electively than high-risk patients (p < 0.001). Length of stay increased from a median (IQR [range]) of 26 (16-43 [0-271]) days in group 50-59 to 35 (21-56 [0-368]) days in group 80+, compared with 17 (10-30 [0-1136]) days for high-risk patients. Rates of unplanned return to the operating theatre were higher in extreme-risk groups compared with high-risk patients (11% vs. 8%). The 90-day survival was 43% in group 50-59, 34% in group 60-69, 27% in group 70-79 and 17% in group 80+. These data underscore the need for a differentiated approach when discussing risk with patients at extreme risk of mortality following an emergency laparotomy. Clinicians should focus on patient priorities on quantity and quality of life during informed consent discussions before surgery. Future work should extend beyond the immediate postoperative period to encompass the longer-term outcomes (survival and function) of patients who have emergency laparotomies.
摘要：
如果需要紧急剖腹手术的患者30天的预测死亡风险≥5％，则将其定义为高风险。尽管死亡率风险评分在5％至50％之间的患者的特征存在很大差异，这些结果由国家紧急剖腹手术审核(NELA)汇总.我们的目的是描述极端死亡风险患者队列的结果，我们定义为NELA预测的30天死亡率≥50%。纳入2012年12月至2020年NELA数据库中的所有患者。我们比较了患者特征；住院时间；计划外返回手术室的比率；以及极端风险组（预计≥50％）和高风险患者（预计5-49％）的90天生存率。在161,337名患者中，5193（3.2%）的预测死亡率≥50%。当患者进一步细分时，2437（47%）的预测死亡率为50-59%（组50-59）；1484（29%）的预测死亡率为60-69%（组60-69）；840（16%）的预测死亡率为70-79%（组70-79）；423（8%）的预测死亡率为≥80%（组80+）。与高危患者相比，高危患者选择性入院的可能性明显更高（p<0.001）。住院时间从50-59组的26（16-43[0-271]）天的中位数（IQR[range]）增加到80+组的35（21-56[0-368]）天，与17（10-30[0-1136]）天相比，高危患者。与高风险患者相比，极端风险组的意外返回手术室的比率更高（11％vs.8%)。90天生存率在50-59组为43%，在60-69组为34%，在70-79组为27%，在80+组为17%。这些数据强调了在与紧急剖腹手术后处于极端死亡风险的患者讨论风险时，需要采取差异化方法。在手术前的知情同意讨论中，临床医生应将重点放在患者的数量和生活质量上。未来的工作应超出术后即刻，以涵盖急诊腹腔镜手术患者的长期结局（生存和功能）。
