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Determinants of Mortality Outcome after Major Laparotomy in a Tertiary Hospital: An Observational Study

K.K. Mubarak, Professor & Head, Department of Anaesthesiology, Government Medical College, Thrissur, Kerala. , K.K. Mubarak* , James Chacko** , Randeep A.M.*** , Aparna Satish***

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Indian Journal of Anesthesia and Analgesia 4(2):p 447-452, April - June 2017. | DOI: http://dx.doi.org/10.21088/ijaa.2349.8471.4217.14

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Abstract

Background: Laparotomy surgery carries significant risk of postoperative mortality due to patient related factors and perioperative events. This observational study was aimed to find out how these factors  affect the mortality outcome in patients undergoing laparotomy surgeries. Methods: All patients who underwent major laparotomy and shifted to Intensive Care Unit/ Post Anaesthesia Care Unit (ICU/ PACU) were analyzed. The parameters studied were age,gender, American Society of Anaesthesiologists’ Physical Status (ASA PS), elective or emergency nature of the surgery, anaesthetic technique used and major complications.The study was conducted over a period of 18 months. The data was analyzed using statistical software version 21.0 and significance was tested by setting the p value at 0.05. Observations: Out of 486 patients, the overall mortality was 37(7.6%). Females predominated (62.1%) with a higher mortality rate of 9.6%. There was no statistically significant difference in mortality amongst the different age groups. The mortality rate was observed as steadily increased as per increased ASA PS score. Patients operated as elective procedure were higher (65.6%),  but the mortality was higher in those patients operated as emergency procedures (18%). Most of the surgeries (93.4%) were under general anaesthesia, but the choice of anaesthetic technique did not affect the mortality. The patients who required vasopressors therapy and mechanical ventilation were higher in the non survivors. Conclusion: The mortality rate of patients undergoing major laparotomy was comparable with similar studies. Females formed the majority and had an increased mortality. Mortality did not increase with age in this study, but increased with higher ASA PS score and emergency surgical procedures. Majority of the surgeries were done under general anaesthesia, but the choice of anaesthetic technique did not affect the outcome. Patients who were dependant on vasopressors and mechanical ventilation had higher mortality rates.

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DOI: http://dx.doi.org/10.21088/ijaa.2349.8471.4217.14

Keywords

Mortality Outcome; Major Laparotomy; Type of Anaesthesia.

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