Audit of emergency preoperative resuscitation

Abstract

A total of 148 patients of mean age 61 years with acute gastrointestinal disease who were assessed as requiring preoperative resuscitation were studied. Overall, the mortality rate was 14·2 per cent and the morbidity rate 50·7 per cent. Resuscitation was associated with a mean(s.e.m.) improvement in predicted mortality rate of 4·2(0·8) per cent and in morbidity rate of 4·3(0·7) per cent. However, there was a group of patients in whom resuscitation was unsuccessful, despite there being no apparent difference in duration or methods of resuscitation from those of the rest of the population studied. A poor response to resuscitation was found in 28 patients; this was commoner in the elderly (P< 0·001) and in women (P< 0·05). Complications were more frequent in patients failing to improve with resuscitation (P< 0·001). In the group deteriorating despite resuscitative efforts, there was a greater proportion of patients with a perforated viscus (P< 0·001), whereas intestinal obstruction was less common (P< 0·05). This study demonstrates that resuscitation can be audited and quantified. Preoperative resuscitation appears to be beneficial, but there is a group that may benefit from synchronous surgery and resuscitation.