Changing Dynamics of Emergency Laparotomies in a Tertiary Care Setup of a Developing Country

Abstract

Background:   Emergency exploratory laparotomy epidemiology is changing due to advances in diagnostic and trauma management. This research sought to assess the current clinical presentation, aetiology and outcomes to show these epidemiological trends.

Materials and Methods:   This was a retrospective descriptive study of the adult population that had an emergency laparotomy in the Surgical Unit I of Holy Family Hospital, Rawalpindi, between January 2022 and August 2023. Demographic data, indications, intra-operative findings and outcomes were evaluated. A comparison was made with the hospital's past records to determine disease trends.

Results:   We analysed 218 patients, with males predominating (60.1%). Acute peritonitis (mostly due to perforated appendix and duodenal ulcers) continued to be the most common indication, followed by trauma (28.5%) and bowel obstruction (mainly adhesive). There was a clear epidemiological shift with a significant increase (p=0.03) in trauma-related laparotomies, compared to the past, and a decrease in infectious causes (such as typhoid). A cancer emergency was found in 5.0% of cases, similar to previous studies but with high acuity. The average hospital stay was 8.9 days and the mortality rate was 9.6% (mostly from sepsis).

Conclusion:   The research supports a shift in the burden of surgical diseases from infections to trauma and cancer, driven by urbanisation and a changing pattern of lifestyle. This requires an adaptation of health policy, with the development of trauma care and early detection of cancer programs