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
Conditions: Mortality, Pediatric, Laparotomy, Emergencies
Sponsor: Jawaharlal Nehru Medical College

Cover Page 
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 
NCT Identifier Number: Not assigned 
Document Date: 31/03/2017 
 
 
 
 
 
 
 
 
 
 
 
 

Aims & Objectives 
The primary objectives of our 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. 
 
 
 
 
 
 
 
 
 
 
 
 
 

Materials & Methods 
This is a prospective study which was conducted at a government teaching institution over a 
period of 24 months. Ethical approval was provided by the Ethical Committee of the University 
and was conducted in accordance with guidelines of Good Clinical Practice and the Declaration 
of Helsinki. Written informed consent was taken from all patients. 
All pediatric patients in the age group of 5 to 10 years presenting with acute abdomen diagnosed 
clinically and radiologically to be having a diagnosis of secondary peritonitis and obstruction; 
who were adequately resuscitated (with a minimum resuscitation period of at least 1 hour) pre-
operatively and underwent definitive surgery by a single surgeon (pediatric surgery senior 
resident) in the emergency were included in the study. Also, only those patients who had a 
PRISM-III (Pediatric Risk of Mortality III) score (Figure 1) of ≤ 8 at presentation were included 
to avoid the confounding effect of pre-operative variables that might affect mortality. All 
patients were adequately resuscitated in terms of temperature, central nervous system (Glasgow 
Coma Scale, pupillary reflexes), cardiovascular system (systolic blood pressure, heart rate) and 
respiratory system (oxygen saturation > 95%,  pCO2 , pH, PaO2) parameters so that they were 
brought within 0 score range of PRISM-III score at the end of resuscitation and before shifting 
to the operation theatre. Furthermore for inclusion only those pediatric patients were considered 
who presented within 72 hours of initial onset of symptoms, operated within 24 hours of initial 
presentation and who died in index hospital admission within 30 days. 
Patients who underwent damage control surgery, whose PRISM – III score was >9 at any point 
of time before undergoing laparotomy or inability to achieve adequate resuscitation (PRISM-
III score >0 before shifting to operation theatre) and/or requirement of resuscitation beyond 4 
hours of presentation were excluded from the study. 

All the patients were shifted to pediatric intensive care unit (PICU) after the operation where 
dedicated staff and pediatrician were available for monitoring of patient.