Socio-economic disparity in risk of undergoing emergency laparotomy and postoperative mortality.

Aims: Socio-economic disparities in health and access to care are well documented, but socio-economic disparities in surgical care and outcomes have received less attention. The aim of the study was to determine if there are socio-economic disparities in the risk of undergoing emergency laparotomy and postoperative mortality in a universal health-care system with free and equal access to care. Methods: This was a nationwide case-control study including patients undergoing non-malignant emergency laparotomy involving resection, ostomy or open drainage between 2003 and 2014 and population references matched 1:1 on age and sex. Socio-economic disparities in one-year postoperative mortality were explored through a cohort study including all patients. Exposure measures were register-based household disposable income, educational level and employment status. Analyses were adjusted by age, sex, country of origin, marital status and co-morbidity. Results: A total of 11,962 cases and 11,962 population references were included. The highest odds ratios (OR) for undergoing surgery were found among those with the lowest income (OR=1.51; 95% confidence interval (CI) 1.39-1.63), those with elementary school education (OR=1.33; 95% CI 1.22-1.46) and those on early-retirement pension (OR=3.49; 95% CI 3.07-3.98). One-year postoperative mortality was highest among those with lowest income (hazard ratio (HR)=1.51; 95% CI 1.35-1.69), those with elementary school education (HR=1.39; 95% CI 1.22-1.59) and those on early-retirement pension (HR=2.12; 95% CI 1.73-2.61). Conclusions: Socio-economic disparities in health exist in relation to non-malignant emergency laparotomies and still exist after adjustment for confounders, including co-morbidity, indicating that mechanisms other than differences in disease burden are involved. There is a substantial need for exploration of mechanisms and preventive measures.

A nationwide cohort study of short- and long-term outcomes following emergency laparotomy.

INTRODUCTION: Emergency laparotomy is a high-risk procedure associated with severe post-operative morbidity and high mortality. The aim was to conduct a nationwide cohort consisting of all patients undergoing emergency laparotomy during an 11-year period and to examine both short- and long-term outcomes. METHODS: Adult patients treated with emergency laparotomy due to gastrointestinal conditions from 2003 through 2013 were identified in the Danish National Patient Register. Demographic data and surgical outcomes were identified in nationwide registers. RESULTS: A total of 47,300 patients were included in the study. Hereof, 15,015 patients underwent minor laparotomy (open appendectomy or cholecystectomy) and the rest underwent major laparotomy (n = 32,285). In all, 8,193 patients (17.3%) were readmitted within 30 days from surgery, whereas 7,521 patients (15.9%) underwent gastrointestinal reoperation. A total of 10,944 patients (23.1%) experienced a post-operative complication. The post-operative mortality at 7, 30, 90 and 365 days was 8.5%, 13.3%, 16.9% and 21.9%, respectively. When excluding minor laparotomies (open appendectomy and cholecystectomy), the 7-, 30-, 90- and 365-day mortality was 12.1%, 18.7%, 23.6% and 30.5%, respectively. CONCLUSIONS: More than one in every five patients died within one year after undergoing emergency laparotomy, and mortality rates were even higher when excluding minor laparotomies as almost one in every three patients died within one year. FUNDING: This study received support from the Frimodt-Heinecke Foundation and from the foundation Manufacturer Frands Køhler Nielsens and wife memorial fund. TRIAL REGISTRATION: The study was registered with Researchregistry.com (Id no: researchregistry2930).