Surgeon perspectives on factors affecting intraoperative complexity in major emergency abdominal surgery: a Danish nationwide survey

Background: The factors contributing to increased intraoperative complexity in major emergency abdominal surgery are not well documented. Several factors could influence surgeons’ expectations regarding intraoperative complexity in emergency settings. The purpose of this study was to investigate surgeons’ expectations regarding how prior and current factors may affect intraoperative complexity in emergency surgery. Methods: The study was an anonymous, case-based questionnaire survey targeting a national cohort of general surgeons in Denmark. The questionnaire included four parts: (1) demographics; (2) rating of factors affecting intraoperative complexity in an emergency laparotomy; (3) ranking of factors by impact on intraoperative complexity; and (4) specification of factors necessitating a consultant’s presence at the start of surgery. Results: The questionnaire was answered by 137 surgeons. Both in-house and on-call surgeons agreed that the prior factors of previous open abdomen and previous abdominal surgery described with difficult conditions had the highest impact on intraoperative complexity. The most important current factors were severe hemodynamic instability and suspected adhesional obstruction in computed tomography. Significant differences were found in the need for consultant presence: previous radiotherapy (3% in-house vs. 39% on-call; p < 0.001), previous open abdomen (23% in-house vs. 47% on-call; p < 0.002), severe hemodynamic instability (46% in-house vs. 65% on-call; p < 0.001), and suspected perforated diverticulitis (18% in-house vs. 33% on-call; p < 0.002). Conclusion: This study revealed a consensus among in-house and on-call surgeons regarding the key factors influencing intraoperative complexity in emergency abdominal surgery, offering valuable insights from the perspective of Danish surgeons.