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

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 extra-abdominal disease over the year 2008. The following variables were compared between survivors (discharged alive from hospital) and non-survivors: (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) pre-operatively: 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 non-specific 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.