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A study of the factors influencing outcome after emergency laparotomy for non-traumatic abdominal pathology

Witherspoon, Jolene 2017. A study of the factors influencing outcome after emergency laparotomy for non-traumatic abdominal pathology. MD Thesis, Cardiff University.
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This thesis investigates prognostic factors influencing the outcome and survival of patients undergoing emergency laparotomy (EL) for non-traumatic abdominal pathology. The hypotheses tested were: deprivation adversely influences EL outcome; accuracy of computed tomography (CT) reports vary and relate to anatomical location of pathology and radiologist; sarcopenia as measured by CT criteria is an important prognostic indicator. Three hundred and thirty-one consecutive patients underwent EL between 1st of January and 31st December 2013 [median age 67 years (18-98), 166 male, 165 female. Thirty day mortality was 16.9% (56/331), 90-day mortality 19.9% (66/331), and overall mortality was 24.5% (81/331). The Welsh Index of Multiple Deprivation (WIMD) was related to 90-day operative mortality (p=0.031), but not 30-day mortality (p=0.061), and lost significance as an independent prognosticator when age and American Society of Anaesthesiology grades were included in regression analysis. Over an eighteen month time period, a larger group of 361 patients [median age 67 years (18–98); 180 male] underwent CT prior to EL. CT reports were deemed accurate in 318 (88.1%) and inaccurate in 43 (11.9%) cases, which resulted in 5 negative laparotomies in this latter cohort (p<0.0001). Accuracy and strength of agreement varied with anatomical location of the pathology; upper gastrointestinal 75.5%, Kw 0.673 (0.531–0.815; p<0.001); small bowel 89.9%, Kw 0.781 (0.687–0.875, p< 0.001); lower gastrointestinal 90.4%, Kw 0.821 (0.749–0.893; p<0.001). CT examinations reported within working hours had higher strength of agreement [Kw 0.832 (0.768–0.896), p<0.001] than CTs reported out of hours [Kw 0.789 (0.721–0.857), p<0.001], but there was no significant difference in overall accuracy (89.9 vs. 86.0%; p=0.253). Reporter seniority was not associated with improved diagnostic accuracy (p=0.177).

Item Type: Thesis (MD)
Date Type: Completion
Status: Unpublished
Schools: Medicine
Date of First Compliant Deposit: 16 July 2018
Last Modified: 05 Feb 2020 04:06

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