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Background: Emergency laparotomy is associated with a high morbidity and mortality rate. The decision on whether to perform an anastomosis or an enterostomy in emergency small bowel resection is guided by surgeon preference alone, and not evidence based. We examined the risks involved in small bowel resection and anastomosis in emergency surgery. Methods: A retrospective study from 2016 to 2019 in a university hospital in Denmark, including all emergency laparotomies, where small‐bowel resections, ileocecal resections, right hemicolectomies and extended right hemicolectomies where performed. Demographics, operative data, anastomosis or enterostomy, as well as postoperative complications were recorded. Primary outcome was the rate of bowel anastomosis. Secondary outcomes were the anastomotic leak rate, mortality and complication rates. Results: During the 3.5‐year period, 370 patients underwent emergency bowel resection. Of these 313 (84.6%) received an anastomosis and 57 (15.4%) an enterostomy. The 30‐day mortality rate was 12.7% (10.2% in patients with anastomosis and 26.3% in patients with enterostomy). The overall anastomotic leak rate was 1.6%, for small‐bowel to colon 3.0% and for small‐bowel to small‐bowel 0.6%. Conclusion: A primary anastomosis is performed in more than eight out of 10 patients in emergency small bowel resections and is associated with a very low rate of anastomotic leak. [ABSTRACT FROM AUTHOR]

Objective: In elective surgery, it is well documented that a midline laparotomy should be closed with a slowly absorbable monofilament suture material in a continuous technique, in a ratio of at least 4 : 1. The evidence concerning the suture material or suturing technique in the emergency setting is lacking. We aimed to investigate whether this technique would reduce the rate of dehiscence. Methods: A standardized procedure of closing the midline laparotomy by using a “small steps” technique of continuous suturing with a slowly absorbable (polydioxanone) suture material in a wound-suture ratio of minimum 1 : 4 was introduced in June 2014. All patients scheduled for any gastrointestinal emergency midline laparotomy were included until October 2015. Pre-, intra-, and postoperative data were registered. All emergency laparotomies performed from 2009 to 2013 served as reference. Chi-squared tests and multivariate Cox regression analysis were performed. Results: We included 494 patients from 2014 to 2015 and 1079 patients from our historical cohort for comparison. All patients had a midline laparotomy in an emergency setting. The rate of dehiscence was reduced from 6.6% to 3.8%, P = 0.03 comparing year 2009 to 2013 with 2014 to 2015. Factors associated with dehiscence were male gender [hazard ratio (HR) 2.8, 95% confidence interval (95% CI) (1.8–4.4), P < 0.001], performance status ≥3 [HR 2.1, 95% CI (1.2–3.7), P = 0.006], cirrhosis [HR 3.8, 95% CI (1.5–9.5), P = 0.004], and retention sutures [HR 2.8, 95% CI (1.6–4.9), P < 0.000]. The 30-day mortality rate was 18.4% in the standardized group vs 22.4% in 2009 to 2013, P = 0.057 and 90-day mortality 24.2% vs 30.4%, P = 0.008. Conclusion: The standardized procedure of closing the midline laparotomy by using a “small steps” technique of continuous suturing with a slowly absorbable (polydioxanone) suture material reduces the rate of fascial dehiscence. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusions Postoperative delirium is a common complication after emergency surgery. Delirium is associated with increased morbidity and mortality. Clinical approach varies and pharmacological treatment is ineffective. We aimed to investigate if a structured non‐pharmacological multidisciplinary intervention could reduce postoperative delirium.An interventional study including all patients aged 65 years or older undergoing major abdominal emergency surgery in an 8 month period. The intervention consisted of improved screening, staff, patient, and family education, ward modifications and nurse‐led daily motor and sensory stimulation.Data was obtained from medical records. Results were compared to an unmatched historic cohort. Primary outcome was occurrence of delirium, secondary outcomes were mortality, postoperative complications, and length of stay.312 patients were included, 81 in the study group and 231 in the control group. Delirium occurred in 6.2% of the interventional group compared to 15.2% in the historic cohort (p = 0.038). In a multivariate regression analysis, the rate of delirium was significantly reduced in the interventional group; OR 0.185 95% CI (0.04–0.81), p = 0.026. The 90 day mortality was 14.8% in the interventional group and 8.7% in the historic cohort (p = 0.116). The rate of overall medical complications was significantly lower in the study group (37% vs. 63%, p < 0.001). Median length of stay was 6 days in both groups.A structured cluster intervention may prevent the occurrence of postoperative delirium. The intervention did not reduce mortality or length of stay, but the need for supplementary nursing staff was eliminated. [ABSTRACT FROM AUTHOR]

Introduction: The present study aimed to evaluate the anastomotic leakage rate in relation to anastomotic technique in right hemicolectomy in a single high-volume centre., Methods: This was a retrospective single-centre study of prospectively collected data of patients undergoing right hemicolectomy or ileocecal resection in an acute or elective setting over a seven-year period in a large University Hospital. Anastomotic leakage, anastomotic technique (hand-sewn versus stapled anastomosis) and potential confounders were registered. The possible confounding risk factors were explored by univariate analysis. Any variables with a p value less-than 0.2 after univariate logistic regression analysis were included in a subsequent multivariate logistic regression analysis., Results: A total of 754 patients had a primary anastomosis performed. In 222 (29%) of the patients, anastomosis was hand-sewn and in 528 (70%) stapled. Overall, 26 patients (3.4%) developed an anastomotic leakage. The anastomotic leakage rate was similar following hand-sewn and stapled anastomoses (3.6% (8/221) versus 3.4% (18/527); p = 0.89). Univariate analyses failed to identify any significant risk factors for anastomotic leakage. A multivariate logistic regression analysis with all mentioned co-variates was performed. None of the included variables were significantly associated with anastomotic leakage., Conclusions: In the present study, we found no significant difference between hand-sewn versus stapled anastomosis., Funding: none., Trial Registration: not relevant., (Articles published in the DMJ are “open access”. This means that the articles are distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits any non-commercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited.)

Introduction: Obstruction of the gastrointestinal tract is a frequent surgical emergency experienced by patients with advanced cancers. We aimed to evaluate factors associated with resumption of post-operative chemotherapy in patients with advanced cancer undergoing explorative laparotomy for bowel obstruction., Methods: This retrospective cohort study was conducted between 2009 and 2013 at Herlev Hospital, Denmark. All patients with advanced cancer were identified from a local electronic database containing all emergency laparotomies. Adult patients with mechanical bowel obstruction were included if they had any kind of cancer and had been under active oncological treatment within the last eight weeks prior to surgery. Demographic, clinical, pre-, and post-operative data were collected and reviewed manually. Multivariate logistic regression analysis was performed to identify predictors for resuming oncological treatment., Results: A total of 76 patients admitted with bowel obstruction and undergoing oncological treatment within eight weeks before surgery were included. Post-operatively, cancer treatment was resumed in 58% of patients. An American Society of Anesthesiologists (ASA) score less-than III (odds ratio = 12.6 (95% confidence interval (CI): 2.9-54.6); p = 0.001) and a performance status less-than 3 (odds ratio = 9.7 (95% CI: 1.4-67.2); p = 0.021) were associated with resuming post-operative cancer treatment., Conclusions: We found that ASA score and performance status are associated with resumption of cancer treatment post-operatively and should be taken into consideration when considering the treatment strategy for patients with advanced cancer and malignant bowel obstruction., Funding: The authors received no financial support for the research, authorship, and/or publication of this article., Trial Registration: not relevant., (Articles published in the DMJ are “open access”. This means that the articles are distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits any non-commercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited.)

Introduction: Adaptive process triage (ADAPT) is a triage tool developed to assess the severity and address the priority of emergency patients. In 2009-2011, ADAPT was the most frequently used triage system in Denmark. Until now, no Danish triage system has been evaluated based on a selective group of patients in need of acute abdominal surgery. Gastrointestinal perforation (GIP) is acknowledged as one of the surgical conditions with the highest mortality rates. The aim of this study was to evaluate whether ADAPT can identify patients with GIP., Methods: All abdominal emergency laparoscopies and laparotomies performed over a one-year period at Herlev Hospital, Denmark, were included. Patient data and triage levels were collected from medical records. We defined patients suspected of less severe surgical illness as green-yellow and patients suspected of severe/life-threatening illness as orange-red., Results: A total of 803 patients with a known triage level were identified: 47% green, 38% yellow, 13% orange and 2% red. Of these patients, 136 were identified with a GIP. The negative predictive value was 83.2% (95% confidence interval: 80.1-85.7), meaning that one out of six abdominal surgery patients triaged as green or yellow had a GIP that was not identified by the triage system., Conclusion: ADAPT is incapable of identifying one of the most critically ill patient groups in need of emergency abdominal surgery., Funding: none., Trial Registration: HEH-2013-034 I-Suite: 02336., (Articles published in the DMJ are “open access”. This means that the articles are distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits any non-commercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited.)