TY - JOUR
T1 - Surgical mortality in patients in extremis
T2 - futility in emergency abdominal surgery
AU - Ramírez-Giraldo, Camilo
AU - Isaza-Restrepo, Andrés
AU - García-Peralta, Juan Camilo
AU - González-Tamayo, Juliana
AU - Ibáñez-Pinilla, Milcíades
N1 - Publisher Copyright:
© 2023, The Author(s).
© 2023. The Author(s).
PY - 2023/1/27
Y1 - 2023/1/27
N2 - Background: The number of older patients with multiple comorbidities in the emergency service is increasingly frequent, which implies the risk of incurring in futile surgical interventions. Some interventions generate false expectations of survival or quality of life in patients and families and represent a negligible therapeutic benefit in patients whose chances of survival are minimal. In order to address this dilemma, we describe mortality in a cohort of patients undergoing emergency laparotomy with a risk ≥ 75% per the ACS NSQIP Surgical Risk Calculator. Methods: A retrospective observational study was designed to analyze postoperative mortality and factors associated with postoperative mortality in a cohort of patients undergoing emergency laparotomy between January 2018 and December 2021 in a high-complexity hospital who had a mortality risk ≥ 75% per the ACS NSQIP Surgical Risk Calculator. Results: A total of 890 emergency laparotomies were performed during the study period, and 50 patients were included for the analysis. Patient median age was 82.5 (IQR: 18.25) years old and 33 (66.00%) were male. The most frequent diagnoses were mesenteric ischemia 21 (42%) and secondary peritonitis 18 (36%). Mortality in the series was 92%. Twenty-four (54.34%) died within the first 24 h of the postoperative period; 11 (23.91%) within 72 h and 10 (21.73%) within 30 days. APACHE II and SOFA scores were statistically significantly higher in patients who died. Conclusions: All available tools should be used to make decisions, with the most reliable and objective information possible, and be particularly vigilant in patients at extreme risk (mortality risk greater than 75% according to ACS NSQIP Surgical Risk Calculator) to avoid futility and its consequences. The available information should be shared with the patient, the family, or their guardians through an assertive and empathetic communication strategy. It is necessary to insist on a culture of surgical ethics based on reflection and continuous improvement in patient care and to know how to accompany them in order to have a proper death.
AB - Background: The number of older patients with multiple comorbidities in the emergency service is increasingly frequent, which implies the risk of incurring in futile surgical interventions. Some interventions generate false expectations of survival or quality of life in patients and families and represent a negligible therapeutic benefit in patients whose chances of survival are minimal. In order to address this dilemma, we describe mortality in a cohort of patients undergoing emergency laparotomy with a risk ≥ 75% per the ACS NSQIP Surgical Risk Calculator. Methods: A retrospective observational study was designed to analyze postoperative mortality and factors associated with postoperative mortality in a cohort of patients undergoing emergency laparotomy between January 2018 and December 2021 in a high-complexity hospital who had a mortality risk ≥ 75% per the ACS NSQIP Surgical Risk Calculator. Results: A total of 890 emergency laparotomies were performed during the study period, and 50 patients were included for the analysis. Patient median age was 82.5 (IQR: 18.25) years old and 33 (66.00%) were male. The most frequent diagnoses were mesenteric ischemia 21 (42%) and secondary peritonitis 18 (36%). Mortality in the series was 92%. Twenty-four (54.34%) died within the first 24 h of the postoperative period; 11 (23.91%) within 72 h and 10 (21.73%) within 30 days. APACHE II and SOFA scores were statistically significantly higher in patients who died. Conclusions: All available tools should be used to make decisions, with the most reliable and objective information possible, and be particularly vigilant in patients at extreme risk (mortality risk greater than 75% according to ACS NSQIP Surgical Risk Calculator) to avoid futility and its consequences. The available information should be shared with the patient, the family, or their guardians through an assertive and empathetic communication strategy. It is necessary to insist on a culture of surgical ethics based on reflection and continuous improvement in patient care and to know how to accompany them in order to have a proper death.
KW - Emergency laparotomy
KW - Futility
KW - Mortality
KW - Risk factors
KW - Surgical ethics
KW - Risk Assessment
KW - Humans
KW - Risk Factors
KW - Male
KW - Quality Improvement
KW - Postoperative Complications/epidemiology
KW - Adolescent
KW - Aged, 80 and over
KW - Medical Futility
KW - Quality of Life
KW - Female
KW - Retrospective Studies
KW - Laparotomy
UR - http://www.scopus.com/inward/record.url?scp=85146878893&partnerID=8YFLogxK
U2 - 10.1186/s12893-022-01897-1
DO - 10.1186/s12893-022-01897-1
M3 - Artículo
C2 - 36703155
AN - SCOPUS:85146878893
SN - 1471-2482
VL - 23
SP - 21
JO - BMC Surgery
JF - BMC Surgery
IS - 1
M1 - 21
ER -