Patients admitted to the ICU for extra-abdominal disease and operated on for emergency laparotomy have significant survival

Abstract

Introduction: Limited data are available concerning patients admitted to the ICU for an extra-abdominal disease and operated on for emergency laparotomy (EL) [1]. We investigated whether such patients had benefit from EL and factors likely to predict survival. Methods: EL was performed in 48 ICU patients admitted for an extraabdominal disease over the year 2008. The following variables were compared between survivors (discharged alive from hospital) and nonsurvivors: (a) sex ratio, BMI; (b) pre-existing co-morbidities considered in seven additive categories: cardiac, respiratory, renal, gastrointestinal, hepatic, diabetes, malignancies, and corticosteroid therapy; (c) preoperatively: IGS II score, mechanical ventilation (MV), vasopressor use, extra-renal epuration requirement, abdominal signs (obstruction, tender ness, contracture, compartment syndrome), records of computed tomography (CT) and ultrasonography examinations; (d) intraoperative findings defined as perforation, infection, ischemia or necrosis of a visceral organ, pancreatitis, bowel obstruction, biliary disease, no finding. The t, Mann-Whitney U, and chi-square tests (P <0.05), and multiple regression analysis (P <0.1) were used. Results: Twenty-six patients (58%) survived. EL was decided because of abdominal signs in 35 patients, lack of improvement of one or several organ failures in 44 patients, specific signs on CT scan, and/or ultrasound examination (active bleeding, subphrenic collection, bowel obstruction, pneumoperitoneum) in 22 patients, or nonspecific signs in 29 patients. EL did not identify any surgical cause in 10 patients. Groups did not differ in intraoperative findings (P = 0.2), preoperative creatinine level (P = 0.3), and preoperative anuria requiring extra-renal epuration (P = 0.2). Groups differed in preoperative MV (P = 0.04), vasopressor requirement (P = 0.02), lactate levels (P = 0.03), IGS II (P = 0.0003), and pre-existing co-morbidities (P = 0.04). No such correlation was found in multivariate analysis (all P >0.15). Conclusions: Neither clinical nor laboratory variables, or operative findings predicted death following EL. The survival rate was high enough to warrant surgical EL for suspected intra-abdominal focus.