Konstantinos Lasithiotakis (Heraklion / GR), Evangelos Kritsotakis (Heraklion / GR), Stamatios Kokkinakis (Heraklion / GR), Georgia Petra (Heraklion / GR), Konstantinos Paterakis (Heraklion / GR), Garyfallia-Apostolia Karali (Heraklion / GR), Vironas Malikides (Heraklion / GR), Charalambos Anastasiadis (Heraklion / GR), Odysseas Zoras (Heraklion / GR), Nikolas Drakos (Patras / GR), Ioannis Kehagias (Patras / GR), Dimitrios Kehagias (Patras / GR), Nikolaos Gouvas (Nicosia / CY), Georgios Kokkinos (Nicosia / CY), Ioanna Pozotou (Nicosia / CY), Panagiotis Papatheodorou (Nicosia / CY), Kyriakos Frantzeskou (Nicosia / CY), Dimitrios Schizas (Athens / GR), Athanasios Syllaios (Athens / GR), Ifestion Palios (Athens / GR), Konstantinos Nastos (Athens / GR), Markos Perdikaris (Athens / GR), Nikolaos Michalopoulos (Athens / GR), Ioannis Margaris (Athens / GR), Evangelos Lolis (Volos / GR), Georgia Dimopoulou (Volos / GR), Dimitrios Panagiotou (Trikala / GR), Vasiliki Nikolaou (Trikala / GR), Georgios Glantzounis (Ioannina / GR), George Pappas-Gogos (Ioannina / GR), Kostas Tepelenis (Ioannina / GR), Georgios Zacharioudakis (Thessaloniki / GR), Savvas Tsaramanidis (Thessaloniki / GR), Ioannis Patsarikas (Thessaloniki / GR), Georgios Stylianidis (Athens / GR), George Giannos (Athens / GR), Michail Karanikas (Alexandroupolis / GR), Konstantinia Kofina (Alexandroupolis / GR), Markos Markou (Alexandroupolis / GR), Emmanuel Chrysos (Heraklion / GR)
Abstract text (incl. references and figure legends)
Introduction: Emergency laparotomy (EL) is accompanied by high postoperative mortality and requires frequently postoperative care in the ICU. Herein, we explore the data of the HELAS study, to identify links between postoperative mortality and ICU stay.
Material and Methods: HELAS is a multicentre prospective study undertaken between 01.2020 and 05.2021 including patients subjected to EL in 11 Greek hospitals. Demographics, clinical variables, and postoperative outcomes were prospectively registered in an online database. Chi-square and t-test was used to compare the distribution of variables between groups.
Results: There were 633 patients, and 30-day postoperative mortality was 16.3%. 119 (18.8%) required postoperative treatment in the ICU and the median ICU stay was 7 days (ΙQR: 5.0-9.7). 100 (15.8%) were admitted in the ICU directly postoperatively, 22 (3.5%) after an initial stay in the ward and their mortality was 43.9% and 59.1%, respectively (p=0.2). 45 out of 103 of the patients who died did not receive any care in the ICU (43.7%). Most of the 189 patients of this cohort who were at very high risk for death (>10%) were not treated in the ICU immediately after surgery (60.5%). 33 out of the 45 patients (73.3%) who did not survive and did not receive ICU care postoperatively were at very high risk for death (>10%) according to the NELA risk calculator and most of them died within the first postoperative week. Post-operative utilisation of ICU was significantly lower in the Greek cohort compared with the NELA audit (25.8% vs 56.8%, p<0.01) and 30-day postoperative mortality was significantly higher (16.3% vs 8.7%), despite similarities in demographics and risks between cohorts.
Conclusions: This study underscores the underutilization of ICU care among patients undergoing emergency laparotomy and are at very high risk for postoperative death.
References:
1. https://doi.org/10.1007/s00268-022-06723-6
2. https://doi.org/10.1093/bja/aet487
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