title: 30-Day and 1-year mortality in emergency general surgery laparotomies: an area of concern and need for improvement?
abstract: OBJECTIVE
  Emergency surgery is associated with poorer outcomes and higher mortality with recent studies suggesting the 30-day mortality to be 14-15%. The aim of this study was to analyse the 30-day mortality, age-related 30-day mortality and 1-year mortality following emergency laparotomy. We hope this will encourage prospective data collection, improvement of care and initiate strategies to establish best practice in this area.
  
  
  METHODS
  This was a retrospective study of patients who underwent emergency laparotomy from June 2010 to May 2012. The primary end point of the study was 30-day mortality, age-related 30-day mortality and 1-year all-cause mortality.
  
  
  RESULTS
  477 laparotomies were performed in 446 patients. 57% were aged <70 and 43% aged >70 years. 30-day mortality was 12, 4% in those aged <70 years and 22% in those >70 years (p < 0.001). 1-year mortality was 25, 15% in those aged under 70 years and 38% in those aged >70 years (p < 0.001).
  
  
  CONCLUSIONS
  Emergency laparotomy carries a high rate of mortality, especially in those over the age of 70 years, and more needs to be done to improve outcomes, particularly in this group. This could involve increasing acute surgical care manpower, early recognition of patients requiring emergency surgery, development of clear management protocols for such patients or perhaps even considering centralisation of emergency surgical services to specialist centres with multidisciplinary teams involving emergency surgeons and care of the elderly physicians in hospital and related community outreach services for post-discharge care.
authors.affiliation: Department of General Surgery, Ninewells Hospital and Medical School, Dundee, DD1 9SY, UK, davidwatt1@nhs.net.
authors.forename: D G
authors.initials: DG
authors.lastname: Watt
authors.forename: M S J
authors.initials: MS
authors.lastname: Wilson
authors.forename: O C
authors.initials: OC
authors.lastname: Shapter
authors.forename: Pradeep
authors.initials: P
authors.lastname: Patil
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D015331:Cohort Studies; D004638:Emergency Treatment / Q000379:methods / Q000401:mortality*; D005260:Female; D013502:General Surgery; D006801:Humans; D015994:Incidence; D007813:Laparotomy / Q000379:methods / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D012189:Retrospective Studies; D018570:Risk Assessment; D013997:Time Factors; D006113:United Kingdom