Relaparotomías en el Servicio de Cirugía de Emergencia del Hospital Nacional Guillermo Almenara Irigoyen

Abstract

Objective: To describe the characteristics of relaparotomies in patients who underwent emergency operations due to acute surgical abdomen in the Emergency Surgery and Critical Care Surgery service of the Guillermo Almenara Irigoyen National Hospital in Lima, Peru. Materials and methods: Patients older than 15 years, who were submitted to one or more relaparotomies as a result of complications following a first surgery due to acute surgical abdomen, from January 1st, 2000 to December 31st, 2013, were included. Operational definition of the following terms was used: relaparotomy (RL), on demand relaparotomy (RLD) and planned relaparotomy (RLP), RLD can be early or late. The primary endpoint was to assess mortality.The guidelines of the Emergency Surgery Service were used and the statistical analysis was performed with
the statistical package STATA 11. Results: There were 5316 surgeries and 1050 RL (19.8%). 4366 patients were operated and 397 patients were reoperated (9.3%). Overall mortality was 5.2% and mortality in those with an RL was 46.1%. There was a direct
relationship between reoperation age and mortality (> 65 years 71% vs. <65 years 29% OR 6.9 CI 4.3-11.1; p <0.05). There were two groups RLP and RLD. The most common indication for RLP was complicated intraabdominal infection (78.87%) and RLD was abdominal sepsis (69.02%). Patients undergoing RLD were 184 (46.35%) and RLP 213 (53.65%) (ns). RLP were 866 surgeries (82.5%) and RLD were 184 surgeries (17.5%). In patients in the RLP group, mortality remained the same in the studied years (p = 0.29). RLD were performed late and early. Late RLDs were more frequent than early RLDs (65.77% vs. 34.23%, p <0.05). Patients with late RLD indication, had a higher mortality rate compared to those who underwent early RLD (61.9% versus 25.4%,
OR 4.7 CI 2.3-10.1, p <0.05). The prevalence of early RLD increased (21.4%, 30.8%, 26.2%, 42.5% and 43.7%, p <0.05) and its mortality decreased (33.3%, 37.5%, 27.3%, 23.5% and 19.0%; p <0.05) in the studied years. Conclusions: RL is a frequent indication in patients undergoing emergency laparotomy (19.8%). Mortality was high (46.1%) and was 7 times higher in patients
over 65 years of age undergoing an RL. The main indication for RLD was abdominal sepsis and for RLP complicated intra-abdominal infection. Late RLD were nearly 5 times more likely to die than those who had early RLD, and there is a significant tendency to perform more early RLD-early and a progressive decline in mortality. Setting up a specialized service in Emergency Surgery can improve results in patients undergoing an RL.