GASTROINTESTINAL DISCONTINUITY AFTER EMERGENCY LAPAROTOMY

Objectives: During emergency laparotomy, patients requiring intestinal resection may be temporarily left in gastrointestinal discontinuity (GID) to shorten operations when faced with hypothermia or hemodynamic instability. Unfortunately, these procedures may result in poor outcomes despite the surgeon’s best efforts. We performed this study to determine predictors of futility for patients initially left in GID after emergency bowel resection.

Methods: We performed a 10-year (2012-2022) retrospective analysis of all patients undergoing exploratory laparotomy that were left in GID at our institution, excluding trauma patients. We divided the patients into three groups: never restored continuity and died (Group 1), restored continuity and died (Group 2), and restored continuity and survived (Group 3). We compared the three groups using single-factor ANOVA for differences in demographics, acuity at presentation, hospital course, laboratory data, comorbidities, and outcomes. Statistically significant findings were subjected to a multivariate regression analysis.

Results: A total of 120 patients were left in GID during the study period. 58 patients (48%) died while 62 patients (52%) survived to discharge. We identified 31 patients (26%) in group 1, 27 patients (22%) in group 2, and 62 patients (52%) in group 3. The results are summarized in table 1 below:

On multivariate logistic regression and only lactate (p = 0.002) and use of vasopressors (p = 0.014) remained significant.

Conclusion: Lactate, INR, smoking, BMI, and the use of vasopressors predicted mortality for patients left in GID after an exploratory laparotomy. Profound lactic acidosis and use of vasopressor therapy could potentially be used to identify futile situations which can direct surgeons and healthcare powers of attorney in making end of life decisions.