Emergencies Clinical Trial
Official title:
A Prospective Study of Evaluation of Operative Duration as a Predictor of Mortality in Pediatric Emergency Surgery: Concept of 100 Minutes Laparotomy in Resource-limited Setting
Introduction Operative duration is an important but under-studied predictor of mortality in
emergency laparotomies.
Aims & Objectives The objective of this study was to quantify the effect of duration of
emergency laparotomy in children on mortality and to identify a rough cut-off duration of
laparotomy to serve as a guide to plan the laparotomy to optimize pediatric surgical patient
outcome.
Operative duration has been found to affect post-operative mortality rates. Operative
duration has been studied in various studies as a risk factor for predicting morbidity and
several other post-operative complications like pneumonia. However, the direct effect of
operative duration on mortality has been studied sparingly and that too mainly in elective
setting and other authors. Thus, operative duration is an under-studied risk factor in
predicting mortality in emergency laparotomies. No study was found during literature review
which predicted mortality as a function of operative duration in emergency laparotomies. Most
studies focused on pre-operative factors and post-operative management for predicting
laparotomy outcomes like the use of POSSUM (Physiological and Operative Severity Score for
the enumeration of Mortality and morbidity) score. Thus, no clear-cut recommendation exists
regarding the optimal time duration for an emergency laparotomy in pediatric population
beyond which a laparotomy must not proceed as it would significantly increase the mortality
rate.
The primary objectives of the study were to quantify the effect of duration of emergency
laparotomy in children on mortality and to identify a rough cut-off duration of laparotomy to
serve as a guide so that such a laparotomy can be planned to optimize pediatric surgical
patient out come in terms of decreased mortality. The secondary objectives included
identifying factors that increase the time of emergency laparotomy and identifying measures
that could be applied to reduce the time of laparotomy significantly and improve outcome.
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