Bedside Exploratory Laparotomy: Factors Associated With Mortality and Clinical Implications in Critically - Ill Patients.

Authors

• Jason M. Aubrey, Corewell Health West Resident
• Apoorva Ojha, Michigan State University College of Human Medicine Medical Student
• Matthew J. Morris, Corewell Health West Resident
• Hannah R. Liefeld, Corewell Health West Resident
• Aryana M. Sharrak-Sitto, Corewell Health West Resident
• Lindsay E Burdett, Priority Health
• Cathryn L. Chadwick, Corewell Health West
• Mathew Chung, Corewell Health West
• G Paul Wright, Corewell Health West

Document Type

Article

Publication Date

4-2026

Publication Title

American Surgeon

Abstract

BACKGROUND: Bedside exploratory laparotomy is a heroic intervention for unstable patients who cannot be transported to the operating room. Given a previously documented high mortality rate, some argue against the procedure on assumption of non-beneficence. This study aims to evaluate procedural mortality rate and identify physiologic factors associated with death after bedside exploration.

METHODS: A single-center, retrospective review of consecutive patients who underwent bedside exploratory laparotomy between 2019 and 2024 was conducted. Patients were stratified into cohorts based on a composite outcome of in-hospital or 30-day survival, and an analysis was conducted to identify factors associated with mortality.

RESULTS: A total of 51 patients underwent bedside exploratory laparotomy, with a mortality rate of 82.4% (42/51) within 30 days or during index hospitalization. The median postoperative time to death was 18.1 hours. Mortality rates were 73.9% in SICU, 90.0% in MICU, and 88.2% in CTICU. Survivors were younger than non-survivors (46.5 vs. 60.8 years; p = 0.025) and had lower Charlson Comorbidity Index scores (2 vs. 4; p = 0.0011). Preoperative lactate was lower (4.12 vs. 10.16 mmol/L; p = 0.0012) and pH higher (7.30 vs. 7.20; p = 0.042) in survivors. Significant intraoperative findings were more frequent in non-survivors (95% vs. 33%; p < 0.001).

CONCLUSION: Bedside exploratory laparotomy is a last-resort intervention with exceedingly high mortality. We observed older patients with significant acidosis or identifiable intraoperative findings have worse prognoses. Preoperative goals-of-care discussions should be prioritized in elderly patients before proceeding with bedside exploration to ensure ethical delivery of surgical care.

First Page

31348261443341

Last Page

31348261443341

Recommended Citation

Aubrey JM, Ojha A, Morris MJ, Liefeld HR, Sharrak-Sitto AM, Burdett LE, et al. [Chadwick CL, Chung M, Wright GP]. Bedside exploratory laparotomy: Factors associated with mortality and clinical implications in critically - ill Patients. Am Surg. 2026:31348261443341. doi: 10.1177/00031348261443341. PMID: 41984048.

DOI

10.1177/00031348261443341

ISSN

1555-9823

PubMed ID

41984048