The Hellenic Emergency Laparotomy Study (HELAS): A Prospective Multicentre Study on the Outcomes of Emergency Laparotomy in Greece
Konstantinos Lasithiotakis, Evangelos I. Kritsotakis, Stamatios Kokkinakis, Georgia Petra, Konstantinos Paterakis, Garyfallia‐Apostolia Karali, Vironas Malikides, Charalampos Anastasiadis, Odysseas Zoras, Nikolas Drakos, Ioannis Kehagias, Dimitrios Kehagias, Nikolaos Gouvas, G Kokkinos, I Pozotou, Panayiotis Papatheodorou, K Frantzeskou, Dimitriοs Schizas, Athanasios Syllaios, Ifaistion M. Palios, Constantinos Nastos, Markos Perdikaris, Nikolaos V. Michalopoulos, Ioannis Margaris, Evangelos Lolis, Georgia Dimopoulou, Dimitrios Panagiotou, Vasiliki Nikolaou, Georgios K. Glantzounis, George Pappas‐Gogos, Kostas Tepelenis, Georgios Zacharioudakis, Savvas Tsaramanidis, Ioannis Patsarikas, Georgios Stylianidis, Georgios Giannos, Michael Karanikas, Konstantinia Kofina, Markos Markou, Emmanuel Chrysos
Abstract
BACKGROUND: Emergency laparotomy (EL) is accompanied by high post-operative morbidity and mortality which varies significantly between countries and populations. The aim of this study is to report outcomes of emergency laparotomy in Greece and to compare them with the results of the National Emergency Laparotomy Audit (NELA). 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.