Operative Duration as a Predictor of Mortality in Pediatric Emergency Surgery
Condition: Mortality; Pediatric; Laparotomy; Emergencies
MeSH terms: Emergencies
Study type: Observational

Summary: 
      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.
    

Detailed description: 
      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.
    

Intervention name(s): Emergency laparotomy
Intervention type(s): Procedure
Intervention description(s): All patients in study underwent emergency laparotomy within 24 hours of presentation after adequate resuscitation of minimum 1 hour.
Observational model: Cohort
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        All pediatric patients presenting to our emergency department 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.
      
Keywords: Operative duration; Pediatric surgery; Emergency laparotomy; Mortality rate; Survival; Kaplan-Meier analysis; ROC curve analysis; Senior resident