A description of patient experience after undergoing an emergency laparotomy.

BACKGROUND

To date, emergency laparotomy outcomes have centred on mortality, while survivorship remains inadequately defined and underexplored. It is expected that survivors are likely to experience significant short- and long-term biopsychosocial challenges and research is key to improving our understanding and identifying areas for improvement. This study aims to describe the emergency laparotomy postoperative pathway and evaluate short- and long-term outcomes.

METHODS

This was a retrospective observational study across three NHS hospitals in Scotland, England and Wales. All patients had undergone emergency laparotomy between December 2017 and January 2019 according to the established National Emergency Laparotomy Audit criteria. Inpatient and post-discharge data were collected, including in-hospital complications, planned surgical follow-up, and unplanned follow-up (representation, readmission, and primary care referrals).

RESULTS

Over the 14-month period, 557 patients were included (Scotland n = 199, Wales n = 252, and England n = 106), with 51.7% female and a median age of 65 years (IQR, 52–75 years). A total of 64.5% of patients had planned surgical follow-up, with a median interval of 9 weeks (IQR, 5–15 weeks). Within 30 days of discharge, 19.3% of patients represented to hospital and 13.3% required readmission. Within two years of discharge, 23.2% had primary care referrals to specialists, primarily general surgery and gastroenterology.

CONCLUSION

Emergency laparotomy is associated with a complex recovery trajectory, with significant variation described. Many patients did not receive planned follow-up, and among those who did, timelines vary from 1 to 4 months. Given the high rates of unplanned follow-up, defining and improving survivorship is urgently needed for this vulnerable patient population.