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Thirty-day mortality following emergency laparotomy is high, and greater amongst elderly patients. Studies systematically describing peri-operative complications are sparse, and heterogeneous. We used the postoperative morbidity survey to describe the type and frequency of complications, and their relationship with outcomes for 144 patients: 114 < 80 years old, and 30 ≥ 80 years old. Cumulative postoperative morbidity survey scores and patterns of morbidity were similar (p = 0.454); however, 28-day mortality was higher in the elderly (10/30 (33.3%) vs. 11/114 (9.6%), p = 0.008), and hospital stay was longer (median (IQR [range]) 17 (13-35 [6-62]) days vs. 11 (7-21 [2-159]) days, p = 0.006). Regression analysis indicated that cardiovascular, haematological, renal and wound complications were associated with longer hospital stay, and that cardiovascular complications predicted mortality. The postoperative morbidity survey system enabled structured mapping of the number and type of complications, and their relationship with outcome, following emergency laparotomy. These results indicate that rather than a greater propensity to complications following surgery, it was the failure to tolerate these that increased mortality in the elderly.

Background. Percutaneous tracheal access is required in more than 40% of major airway emergencies, and rates of failure are high among anaesthetists. Supraglottic airway management is more likely to fail in patients with obesity or neck pathology. Commercially available manikins may aid training. In this study, we modified a standard ‘front of neck’ manikin and evaluated anaesthetists’ performance of percutaneous tracheal access. Methods.Twocricothyroidotomytrainingmanikinsweremodifiedusingsectionsofbellypork to simulate a morbidly obese patient and an obese patient with neck burns. An unmodified manikin was used to simulate a slim patient. Twenty consultant anaesthetists were asked to manage a ‘can’t intubate, can’t ventilate’ scenario involving each of the three manikins. Outcome measures were success using their chosen technique and time to first effective breath. Results. Success rates using first-choice equipment were: ‘slim’ manikin 100%, ‘morbidly obese’ manikin 60%, and ‘burned obese’ manikin 77%. All attempts on the ‘slim’ manikin succeeded within 240 s, the majority within 120 s. In attempts on the ‘morbidly obese’ manikin, 60% succeeded within 240 s and 20% required more than 720 s. All attempts on the ‘burned obese’ manikin succeeded within 180 s. Conclusions. Significantly greater technical difficulty was experienced with our ‘morbidly obese’ manikin compared with the unmodified manikin. Failure rates and times to completion were considerably more consistent with real-life reports. Modifying a standard manikin to simulate an obese patient is likely to better prepare anaesthetists for this challenging situation. Development of a commercial manikin with such properties would be of value.