Improving outcomes after emergency laparotomy surgery

Dr Ximena Watson

Emergency laparotomy surgery is associated with a high risk of morbidity and mortality.  The incidence of pulmonary complications following emergency laparotomy surgery has been quoted as high as 23 % and over recent years there has been an increased focus on improving outcomes. Pulmonary complications are potentially modifiable via both surgical and anaesthetic techniques.  Recent evidence has indicated that the use of Lung Protective Ventilation (LPV) may be beneficial at reducing the risk of postoperative pulmonary complications (PPCs). The ALPINE study, published online in the BJA in 2018 examined the ventilator strategies employed in patients undergoing emergency laparotomy surgery and demonstrated that less than 5% of patients were ventilated using a LPV strategy and that both peak pressure and fraction of inspired oxygen concentration (FiO2) were modifiable factors significantly associated with the development of postoperative pulmonary complications (PPCs). Further research is warranted to determine whether manipulation of these factors can influence outcome.