Surgery · Medical Literature
Unplanned Healthcare Utilization After Emergency Laparotomy: A Systematic Review and Meta-Analysis.
Abstract
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. 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. 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. 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.
Clinical relevance
What is the pooled incidence of unplanned hospital readmission and emergency department utilization following non-trauma emergency laparotomy in adults, and what patient-level risk factors and diagnoses drive these events? __SNAPSHOT__ {"studyDesign":"Systematic review with meta-analysis of prevalence/incidence studies","setting":"International; multi-database search (MEDLINE, Embase, Cochrane Library); institutional types and geographic distribution of included studies not reported in the abstract","sampleSize":"n = 78,387 total patients across 10 included studies; readmission meta-analysis subset: n = 1,907; ED utilization meta-analysis subset: n = 2,004","population":"Adults undergoing non-trauma emergency laparotomy for perforated viscera, intestinal obstruction, mesenteric ischemia, or intra-abdominal bleeding","intervention":"Non-trauma emergency laparotomy (index procedure; no experimental intervention)","comparator":"Not applicable (single-arm prevalence/incidence meta-analysis)","primaryOutcome":"All-cause hospital readmission and emergency department (ED) utilization within 30, 90, and 180 days post-discharge","followUp":"30 days (primary analysis); 90 and 180 days (reported as additional time points; pooled estimates at these intervals not reported in the available abstract)","fundingSource":"Not reported"}
Key findings
Among 1,907 patients contributing to the hospital readmission meta-analysis, the pooled 30-day all-cause readmission rate was 17% (95% CI 16–19%; prediction interval [PI] 15–20%). Among 2,004 patients contributing to the ED utilization analysis (3 studies), the pooled 30-day ED utilization rate was 28% (95% CI 18–40%; PI 12–53%). The wide prediction interval for ED utilization (12–53%) signals substantial between-study heterogeneity and indicates that individual institution rates may deviate considerably from the pooled estimate. Pooled 90-day and 180-day readmission or ED utilization rates were not reported in the available abstract. Discharge disposition was identified as an independent risk factor for unplanned hospital utilization in two studies. The leading causes of post-discharge hospital utilization were wound-related complications, abdominal complaints, dehydration, and infections. No NNT/NNH is calculable from the data available (observational prevalence data; no comparator group). No intervention-related adverse events are applicable to this study design.
Practice implications
This systematic review establishes that approximately 1 in 6 adult patients undergoing non-trauma emergency laparotomy is readmitted to hospital within 30 days, and approximately 1 in 4 presents to an ED within the same window. These rates are clinically significant and substantially exceed readmission benchmarks for elective abdominal surgery. The findings apply to patients undergoing emergency laparotomy for the four index diagnoses studied (perforated viscera, bowel obstruction, mesenteric ischemia, intra-abdominal bleeding), but trauma laparotomy patients were explicitly excluded and findings should not be extrapolated to that population. The study identified discharge disposition as a modifiable risk factor, suggesting that targeted discharge planning and transition-of-care interventions—particularly for patients discharged to facilities or home with limited support—may represent actionable quality improvement targets. Wound complications, abdominal complaints, dehydration, and infections as leading causes point to potentially preventable readmissions amenable to structured post-discharge surveillance. However, the very wide PI for ED utilization (12–53%) and the limited number of studies (10 total, with only 3 contributing ED data) constrain confidence in precise institutional benchmarking. The GRADE certainty of evidence was assessed but the rating level is not reported in the available abstract, which is a key interpretive limitation. Importantly, 90- and 180-day pooled estimates and risk factor effect sizes were not reported in the abstract; this summary is accordingly limited to abstract-level data only. __LIMITATIONS__ Only 10 studies were included in the meta-analysis, with only 7 contributing to the hospital readmission pool (n = 1,907) and only 3 to the ED utilization pool (n = 2,004)—the overall sample contributing to pooled estimates is small relative to the 78,387 total patients, the majority of whom came from large registry studies not stratified by the primary outcomes.,Extreme heterogeneity in the 30-day ED utilization estimate (95% CI 18–40%; PI 12–53%) substantially limits the clinical utility of this pooled figure for institutional benchmarking.,The review was restricted to non-trauma emergency laparotomy for four specific indications; findings may not generalize to other emergency abdominal operative scenarios (e.g., trauma, emergency laparoscopy, or mixed urgent surgery cohorts).,90-day and 180-day readmission data were pre-specified primary outcomes but pooled estimates for these time points are not provided in the available abstract, representing a significant gap in the evidence summary.,Discharge disposition was the only risk factor identified across ≥2 studies; a comprehensive, quantitatively pooled risk factor analysis was not achievable, indicating sparse and heterogeneous secondary outcome data.,Studies included were prevalence/incidence designs (observational); confounding by indication, case-mix differences across institutions, and variability in readmission definitions across studies are probable sources of bias.,The GRADE certainty rating is noted but not specified in the abstract, preventing determination of overall evidence quality.,Funding source is not reported, precluding assessment of industry sponsorship bias.,Generalizability is uncertain given the unknown geographic distribution and institutional variety of included studies. __BOTTOM_LINE_CATEGORY__ potentially_practice_informing __BOTTOM_LINE__ Approximately 17% of adults (95% CI 16–19%) are re-hospitalized within 30 days of non-trauma emergency laparotomy, and 28% (95% CI 18–40%) utilize the emergency department within the same period—rates that represent a significant burden on health systems and patients. Wound complications, abdominal complaints, dehydration, and infections are the dominant drivers, and discharge disposition is a consistent independent risk factor, pointing to targeted post-discharge care as the primary lever for improvement. These findings are hypothesis-generating and support quality improvement efforts, but the small number of contributing studies, high heterogeneity in ED utilization data, and absent 90- and 180-day pooled results mean this evidence should inform—not yet prescribe—formal post-discharge monitoring protocols.