Triage and Outcomes for a Whole Cohort of Patients Presenting for Major Emergency Abdominal Surgery Including the No-LAP Population: A Prospective Single-Center Observational Study

Background :Clinical outcomes for patients with an indication for major emergency abdominal surgery, who do not proceed to the operating room, are not well characterised in the existing literature. Triage criteria may vary between centres, which could significantly impact reported postoperative outcomes. Methods :We aimed to characterise the entire population presenting with an indication for acute high-risk abdominal surgery, including patients not proceeding to surgery, in a prospective observational single-center study in a high-volume Danish center. In all, 252 consecutive patients presenting with acute surgical abdominal pathology, where major emergent abdominal surgery was indicated, were prospectively included from 15 th October 2020 to 15 th August 2021. Results :Overall, 21 patients (8.3%) of our total study cohort did not proceed to surgery. These patients were significantly older, more comorbid with higher ASA scores, poor performance status, and were more likely to have bowel ischemia. Poor functional performance and surgeons’ consideration of futile intervention were the main reasons for the decision not to operate in all 21 patients. Overall, 30-day mortality was 95% for the No-LAP cohort, 9% for the LAP cohort, and 16% for the whole cohort respectively. Thus, indicating the No-LAP group selection as one of the main determinants of overall outcome and postoperative reported outcome. Conclusions : There is a need for prospective international multi-center studies to characterise the entire cohort of patients eligible for emergency laparotomy including the No-LAP population, as large variations in triage criteria and culture seem to exist. Trial registration : Retrospectively registered.