The Hellenic Emergency Laparotomy Study (HELAS): A Prospective Multicentre Study on the Outcomes of Emergency Laparotomy in Greece.
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Lasithiotakis Konstantinos, Kritsotakis Evangelos I, Kokkinakis Stamatios, Petra Georgia, Paterakis Konstantinos, Karali Garyfallia-Apostolia, Malikides Vironas, Anastasiadis Charalampos S, Zoras Odysseas, Drakos Nikolas, Kehagias Ioannis, Kehagias Dimitrios, Gouvas Nikolaos, Kokkinos Georgios, Pozotou Ioanna, Papatheodorou Panayiotis, Frantzeskou Kyriakos, Schizas Dimitrios, Syllaios Athanasios, Palios Ifaistion M, Nastos Konstantinos, Perdikaris Markos, Michalopoulos Nikolaos V, Margaris Ioannis, Lolis Evangelos, Dimopoulou Georgia, Panagiotou Dimitrios, Nikolaou Vasiliki, Glantzounis Georgios K, Pappas-Gogos George, Tepelenis Kostas, Zacharioudakis Georgios, Tsaramanidis Savvas, Patsarikas Ioannis, Stylianidis Georgios, Giannos Georgios, Karanikas Michael, Kofina Konstantinia, Markou Markos, Chrysos Emmanuel
Аннотация
METHODS: This is a multicentre prospective cohort study undertaken between 01.2019 and 05.2020 including consecutive patients subjected to EL in 11 Greek hospitals. EL was defined according to NELA criteria. Demographics, clinical variables, and post-operative outcomes were prospectively registered in an online database. Multivariable logistic regression analysis was used to identify independent predictors of post-operative mortality.
RESULTS: There were 633 patients, 53.9% males, ASA class III/IV 43.6%, older than 65 years 58.6%. The most common operations were small bowel resection (20.5%), peptic ulcer repair (12.0%), adhesiolysis (11.8%) and Hartmann's procedure (11.5%). 30-day post-operative mortality reached 16.3% and serious complications occurred in 10.9%. Factors associated with post-operative mortality were increasing age and ASA class, dependent functional status, ascites, severe sepsis, septic shock, and diabetes. HELAS cohort showed similarities with NELA patients in terms of demographics and preoperative risk. Post-operative utilisation of ICU was significantly lower in the Greek cohort (25.8% vs 56.8%) whereas 30-day post-operative mortality was significantly higher (16.3% vs 8.7%).
CONCLUSION: In this study, Greek patients experienced markedly worse mortality after emergency laparotomy compared with their British counterparts. This can be at least partly explained by underutilisation of critical care by surgical patients who are at high risk for death.