title: Morbidity and mortality rates after emergency abdominal surgery: an analysis of 4346 patients scheduled for emergency laparotomy or laparoscopy.
abstract: OBJECTIVE
  Emergency abdominal surgery results in a high rate of post-operative complications and death. There are limited data describing the emergency surgical population in details. We aimed to give a detailed analyses of complications and mortality in a consecutive group of patients undergoing acute abdominal surgery over a 4-year period.
  
  
  METHODS
  This observational study was conducted between 2009 and 2013 at Copenhagen University Hospital Herlev, Denmark. All patients scheduled for emergency laparotomy or laparoscopy were included. Pre-, intra-, and post-operative data were collected from medical records. Complications were registered according to the Clavien-Dindo classification. Cox regression analysis was performed to identify risk factors for mortality.
  
  
  RESULTS
  A total of 4,346 patients underwent emergency surgery, of whom 14 % had surgical complications and 23 % medical complications. The overall 30-day mortality was 8 % with 50 % of those in this group over 80 years of age. The 30-day mortality rates were 0.8 % (95 % CI 0.5-1.1) and 17 % (95 % CI 15.5-18.9), respectively, for the laparoscopy and the laparotomy groups. The overall death rate within 24 h of surgery was 21 %. Several risk factors for 30- and 90-day mortality were identified: age, ASA ≥3 (American Society of Anaesthesiologists physical status classification), performance score (Zubroed/WHOclassification), cirrhosis of the liver, chronic nephropathy, several medical conditions, and malignancy.
  
  
  CONCLUSIONS
  Almost one in five patients died after emergency laparotomy, of whom one in five died within 24 h of surgery. Predictors for poor outcome were identified.
authors: Department of Gastrointestinal Surgery, Copenhagen University Hospital, Herlev, Herlev, Denmark. m.tolstrup@dadlnet.dk.
authors: Mai-Britt
authors: http://orcid.org/0000-0001-7828-2229
authors: MB
authors: Tolstrup
authors: Department Surgery, Center for Surgical Science, Zealand University Hospital, Copenhagen University, Koege, Denmark.
authors: Sara Kehlet
authors: SK
authors: Watt
authors: Department Surgery, Center for Surgical Science, Zealand University Hospital, Copenhagen University, Koege, Denmark.
authors: Ismail
authors: I
authors: Gögenur
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003718:Denmark; D004630:Emergencies; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects* / Q000401:mortality*; D007813:Laparotomy / Q000009:adverse effects* / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications / Q000453:epidemiology*; D012307:Risk Factors; D055815:Young Adult
keywords: Clavien-Dindo classification; Emergency abdominal surgery; Morbidity; Mortality; Risk factors