AUDIT OF EMERGENCY PREOPERATIVE RESUSCITATION

A total of 148 patients of mean age 61 years with acute gastrointestin al disease who were assessed as requiring preoperative resuscitation w ere studied. Overall, the mortality rate was 14.2 per cent and the mor bidity 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 th ose of the rest of the population studied. A poor response to resuscit ation 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 patien ts failing to improve with resuscitation (P<0.001). In the group deter iorating despite resuscitative efforts, there was a greater proportion of patients with a perforated viscus (P<0.001), whereas intestinal ob struction was less common (P<0.05). This study demonstrates that resus citation can be audited and quantified. Preoperative resuscitation app ears to be beneficial, but there is a group that may benefit from sync hronous surgery and resuscitation.