Unplanned Healthcare Utilization After Emergency Laparotomy: A Systematic Review and Meta-Analysis

BACKGROUND: Readmissions following emergency laparotomy are frequent, and mainly a result of late-onset postoperative complications, worsening of pre-existing comorbidities, and non-compliance with care instructions. This review aimed to describe current evidence on readmission after emergency laparotomy.

METHODS: A systematic search was performed in MEDLINE, Embase, and the Cochrane Library. Studies were included if they reported readmission incidence following non-trauma emergency laparotomy for perforated viscera, intestinal obstruction, mesenteric ischemia, or intraabdominal bleeding in adults. Bias was assessed with The JBI Checklist for Prevalence Studies, and certainty of the evidence was assessed using GRADE. The primary outcomes were all-cause hospital readmission and emergency department utilization within 30-, 90-, and 180 days. Secondary outcomes were risk factors and leading causes for readmission.

RESULTS: In total, 78,387 patients (10 studies) were included. Three studies reported on emergency department utilization, and the remaining reported on hospital readmission. The pooled 30-day hospital readmission rate for 1907 patients was 17% (95% confidence interval (CI) = 16-19%; prediction interval (PI) = 15-20%), and the pooled 30-day emergency department utilization for 2004 patients was 28% (95% CI = 18-40%; PI = 12-53%). Two studies reported discharge disposition as an independent risk factor of hospital utilization. The leading causes of hospital utilization were wound-related, abdominal complaints, dehydration and infections.

CONCLUSIONS: The cumulative incidence of 30-day hospital readmission following emergency laparotomy was 16%-19%. These high readmission rates raise global concern, as they may strain hospital resources and compromise quality of care for all patients in need of urgent care.