The Hellenic Emergency Laparotomy Study (HELAS): A Prospective Multicentre Study on the Outcomes of Emergency Laparotomy in Greece.

Autor: Lasithiotakis K; Department of General Surgery, School of Medicine, University Hospital of Heraklion, University of Crete, Heraklion, Crete, Greece. k.lasithiotakis@uoc.gr.; Department of General Surgery, University Hospital of Crete, 71110, Heraklion, Greece. k.lasithiotakis@uoc.gr., Kritsotakis EI; Laboratory of Biostatistics, School of Medicine, University of Crete, Heraklion, Crete, Greece., Kokkinakis S; Department of General Surgery, School of Medicine, University Hospital of Heraklion, University of Crete, Heraklion, Crete, Greece., Petra G; Department of General Surgery, School of Medicine, University Hospital of Heraklion, University of Crete, Heraklion, Crete, Greece., Paterakis K; Department of General Surgery, School of Medicine, University Hospital of Heraklion, University of Crete, Heraklion, Crete, Greece., Karali GA; Department of General Surgery, School of Medicine, University Hospital of Heraklion, University of Crete, Heraklion, Crete, Greece., Malikides V; Department of General Surgery, School of Medicine, University Hospital of Heraklion, University of Crete, Heraklion, Crete, Greece., Anastasiadis CS; Department of Surgical Oncology, School of Medicine, University Hospital of Heraklion, University of Crete, Heraklion, Crete, Greece., Zoras O; Department of Surgical Oncology, School of Medicine, University Hospital of Heraklion, University of Crete, Heraklion, Crete, Greece., Drakos N; Department of Surgery, School of Medicine, University General Hospital of Patras, University of Patras, Patras, Greece., Kehagias I; Department of Surgery, School of Medicine, University General Hospital of Patras, University of Patras, Patras, Greece., Kehagias D; Department of Surgery, School of Medicine, University General Hospital of Patras, University of Patras, Patras, Greece., Gouvas N; Department of Surgery, School of Medicine, General Hospital of Nicosia, University of Cyprus, Nicosia, Cyprus., Kokkinos G; Department of Surgery, School of Medicine, General Hospital of Nicosia, University of Cyprus, Nicosia, Cyprus., Pozotou I; Department of Surgery, School of Medicine, General Hospital of Nicosia, University of Cyprus, Nicosia, Cyprus., Papatheodorou P; Department of Surgery, School of Medicine, General Hospital of Nicosia, University of Cyprus, Nicosia, Cyprus., Frantzeskou K; Department of Surgery, School of Medicine, General Hospital of Nicosia, University of Cyprus, Nicosia, Cyprus., Schizas D; First Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece., Syllaios A; First Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece., Palios IM; Second Propaedeutic Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece., Nastos K; Department of Surgery, School of Medicine, University General Hospital Attikon, University of Athens, Athens, Greece., Perdikaris M; Department of Surgery, School of Medicine, University General Hospital Attikon, University of Athens, Athens, Greece., Michalopoulos NV; Department of Surgery, School of Medicine, University General Hospital Attikon, University of Athens, Athens, Greece., Margaris I; Department of Surgery, School of Medicine, University General Hospital Attikon, University of Athens, Athens, Greece., Lolis E; Department of Surgery, General Hospital of Volos, Volos, Greece., Dimopoulou G; Department of Surgery, General Hospital of Volos, Volos, Greece., Panagiotou D; Department of Surgery, General Hospital of Trikala, Trikala, Greece., Nikolaou V; Department of Surgery, General Hospital of Trikala, Trikala, Greece., Glantzounis GK; Department of Surgery, University Hospital of Ioannina, Ioannina, Greece., Pappas-Gogos G; Department of Surgery, University Hospital of Ioannina, Ioannina, Greece., Tepelenis K; Department of Surgery, University Hospital of Ioannina, Ioannina, Greece., Zacharioudakis G; Department of Surgery, School of Medicine, Ippokrateio General Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki, Greece., Tsaramanidis S; Department of Surgery, School of Medicine, Ippokrateio General Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki, Greece., Patsarikas I; Department of Surgery, School of Medicine, Ippokrateio General Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki, Greece., Stylianidis G; 2nd Department of Surgery, Evangelismos General Hospital, Athens, Greece., Giannos G; 2nd Department of Surgery, Evangelismos General Hospital, Athens, Greece., Karanikas M; Department of Surgery, School of Medicine, University General Hospital of Alexandroupolis, University of Thrace, Alexandroupolis, Greece., Kofina K; Department of Surgery, School of Medicine, University General Hospital of Alexandroupolis, University of Thrace, Alexandroupolis, Greece., Markou M; Department of Surgery, School of Medicine, University General Hospital of Alexandroupolis, University of Thrace, Alexandroupolis, Greece., Chrysos E; Department of General Surgery, School of Medicine, University Hospital of Heraklion, University of Crete, Heraklion, Crete, Greece.
Jazyk: angličtina
Zdroj: World journal of surgery [World J Surg] 2023 Jan; Vol. 47 (1), pp. 130-139. Date of Electronic Publication: 2022 Sep 15.
DOI: 10.1007/s00268-022-06723-6
Abstrakt: 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.
(© 2022. The Author(s).)
Databáze: MEDLINE
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