Complications and outcomes of patients after emergency laparotomy.

Thesis event information

Date and time of the thesis defence

Place of the thesis defence

Oulu University Hospital lecture hall 1, Kajaaninkatu 50

Topic of the dissertation

Complications and outcomes of patients after emergency laparotomy.

Doctoral candidate

Medical doctor Aura Tellervo Ylimartimo

Faculty and unit

University of Oulu Graduate School, Faculty of Medicine, Translational Medicine Research Unit

Subject of study



Professor Ari Leppäniemi, University of Helsinki


Professor Janne Liisanantti, University of Oulu

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Complications and outcomes of patients after emergency laparotomy.

Emergency laparotomy (EL) is one of the most common emergency gastrointestinal procedures. A limited number of studies focus on the onset of postoperative complications, long-term mortality and the impact of preoperative quality of life (QoL) on the rate of postoperative complications after EL.
This thesis examined the factors associated with postoperative complications after EL as well as their impact on short- and long-term outcomes. In addition, this thesis assessed whether the preoperative QoL affects the rate of postoperative complications. The thesis consists of one prospective and three retrospective studies. Overall, these studies comprised a total of 1 299 EL patients operated during 2005–2022 at Oulu University Hospital, Finland.
The QoL before EL was evaluated using the RAND-36 questionnaire. Patients with postoperative complications reported lower general health in RAND-36 domains than patients without complications. Medical complications occurred mainly in the early postoperative phase while operation-related complications occurred later. Of 674 EL patients, 50% had medical complications and 30% had operation-related complications. In multivariate analysis, patient-related factors such as advanced age, high ASA and preoperative CRP and low albumin were risk factors for medical complications. Patients with medical complications had higher 30-day mortality than patients with operation-related complications (17.2% vs. 13.5%). Both short- and long-term mortality was significantly worse in EL patients with postoperative complications compared to patients without complications: 30-day mortality 15.9% vs. 5.3%, 90-day mortality 24.7% vs. 8.4%, and 2-year mortality 39.3% vs. 17.5%. In multivariate analysis, high ASA and CCI scores and longer duration of operation were associated with mortality after EL in patients surviving more than 90 days. EL patients who required ICU treatment within 48 hours of surgery had high mortality rates; the 5-year mortality was 58%.
EL patients are at high risk for postoperative complications, and mortality after EL is significant. By taking into account the onset of complications and risk factors the early identification of complications can be improved and their treatment made more effective.
Last updated: 2.10.2023