Emergency surgery >> Postoperative complications within 30 days of surgery

Graft complications were reported in 14% (33/242) of cases, double the incidence in the elective setting (6%). 14 patients (6%, 14/242) were returned to theatre and three of these required an amputation.

There were few complications reported related to limb ischaemia. Three patients out of the 239 (1%) required amputation and three had to return to theatre for other reasons.

28% (66/238) had a postoperative infection and for 26 patients it was unknown whether there had been any infections. The most common infections were chest infections (20%, 46/238) and no patient developed a graft infection within 30 days of surgery.

17% (37/223) of patients were reported to have had a myocardial infarction. 15 questionnaires were marked unknown and 26 questions were left unanswered. No specific criteria for diagnosis of infarction were laid down in the questionnaire, so in addition some silent myocardial infarcts may have not been reported. 57% (21/37) of those who had an infarct died within 30 days of surgery compared with 18% of those who did not.

Table 20 shows the emergency operations grouped according to the highest position at which the clamp was placed.

Table 20. Position of aortic clamp
Position of clamp	Total	%
Sub-diaphragmatic	13	5
Supra-renal	19	8
Infra-renal	211	87
Sub-total	243
Unknown	10
Not answered	11
Total	264

The development of renal impairment after elective surgery was divided into those patients showing a rise in urea > 5 mmol/l above preoperative level and those who required renal support (Table 21).

Table 21. Number of cases with postoperative renal impairment
Renal impairment	Total	%
None	141	64
Urea > 5 mmol above preoperative level	49	22
Requiring haemofiltration / dialysis	30	14
Sub-total	220
Unknown	12
Not answered	32
Total	264

Renal failure was commonly associated with mortality. 39% (19/49) of patients who developed a raised urea died, and 60% (18/30) of patients who required renal support died.

Eight patients (3%, 8/236) were reported to have suffered a stroke within 30 days of surgery; three disabling and two non-disabling. The three remaining patients were reported to have had an ‘other’ type of stroke. Three of the eight patients reported as having strokes died.

Five patients (2%, 5/230) developed ischaemic bowel, (confirmed either at laparotomy, by mucosal changes at endoscopy or at autopsy). One patient survived.

One patient developed paraplegia and died.

‘Other’ complications were reported for 35% (64/184) of patients.