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

• Published in: Journal of postgraduate medicine (Bombay) 2019-01, Vol.65 (1), p.24-32
• Main Authors: Kaushal-Deep, S, Ahmad, R, Lodhi, M, Chana, R
• Format: Article
• Language: English
• Subjects: Age groups; Care and treatment; Children; Collaboration; Hospitals; Laparotomy; Methods; Morbidity; Mortality; Original; Outcome and process assessment (Medical care); Patient outcomes; Patients; Pediatric emergencies; Pediatric surgery; Pediatrics; Prognosis; Studies; Surgeons; Surgery; Variance analysis
• ISSN: 0022-3859; 0972-2823
• DOI: 10.4103/jpgm.JPGM_52_18

Introduction: Operative duration is an important but under-studied predictor of mortality in emergency laparotomies. Aims and Objectives: The primary 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 so that a laparotomy can be planned to optimize pediatric surgical patient outcome. Materials and Methods: This is a prospective study conducted in a government tertiary teaching institution over a period of 24 months. All children in the age group of 5-10 years presenting in the emergency department with Pediatric Risk of Mortality III score ≤8, undergoing emergency laparotomy in emergency operation theater, were included. Observations and Results: In all, 213 children were included in the study. The mean time from presentation to shifting to the operating room was 3.7 h. The mean operative duration was 108 min. The mean operative time in survived patients was 102 min as compared to 135 min in expired patients (P < 0.05). The 30-day in-hospital mortality rate was 17.4%. After application of binary logistic regression analysis, it was found that time to laparotomy and operative duration were significant risk factors (