[Show abstract][Hide abstract] ABSTRACT: Data on outcomes of patients who underwent emergency laparotomy (EML) are limited. This prospective observational study examined aspects of inpatient care and outcomes following EML with a view to identifying predictors of mortality.
Data collected from consecutive inpatients who underwent EML in a UK teaching hospital over a 3-month period included perioperative physiology, treatment, morbidity, and mortality (30-day, in-hospital, 12-month, and 24-month). Univariate and multiple logistic regression analyses were used to identify predictors of mortality.
Eighty-five patients (44 male) with a mean ± SD age of 61 ± 18 years were studied. Postoperatively, 51 % of patients were admitted to the intensive care (ICU) or the high-dependency unit (HDU). 30-day, in-hospital, 12-month, and 24-month mortality was 14, 16.5, 22.4, and 25.9 %, respectively. After adjusting for confounding variables, age ≥70 years (odds ratio [OR] = 9.2, P = 0.004) and a need for postoperative ICU/HDU (OR = 15.0, P = 0.014) were independent predictors of 30-day mortality. Independent predictors of in-hospital mortality were age ≥70 years (OR = 18.2, P = 0.016), ASA ≥III (OR = 22.1, P = 0.034), preoperative sepsis (OR = 20.6, P = 0.045), and need for postoperative ICU/HDU (OR = 21.5, P = 0.038). Independent predictors of 12-month mortality were preoperative urea >7.5 mmol/L (OR = 3.5, P = 0.038) and need for postoperative ICU/HDU (OR = 3.7, P = 0.044). Age ≥70 years was the only independent predictor of 24-month mortality (OR = 4.5, P = 0.014). Almost all deaths recorded in the 24 months following surgery resulted from disseminated malignancy.
Patients who underwent EML had favourable outcomes, with 2-year survival close to 75 %. Age ≥70 years and the need for postoperative ICU/HDU care were independent predictors of mortality.
World Journal of Surgery 04/2012; 36(9):2060-7. DOI:10.1007/s00268-012-1614-0 · 2.35 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Up to 30% of surgical inpatients develop complications related to fluid and electrolyte therapy. We sought to study the occurrence of hypo- and hypernatraemia in these patients to inform current standards of care.
This prospective audit took place over 80 days in a university hospital. Patients with a serum sodium concentration less than 130 or greater than 150 mmol/l were included. Daily intakes of Na(+), K(+) and Cl(-), and fluid balance were recorded before and after development of dysnatraemia. Fluid balance charts were assessed, as was the presence of documented patient weights. Patients were followed up until one of these milestones was reached: normonatraemia, death, or hospital discharge.
During the study period 55 (4%) of the 1,383 surgical admissions met the inclusion criteria. Fifteen patients had hypernatraemia, 13 (87%) of whom were identified on ICU/HDU. In the days preceding the hypernatraemia, patients received (in mmol/day) a median (IQR) of 157 (76-344) Na(+), 38 (6-65) K(+), 157 (72-310) Cl(-), and 1.96 (1.13-2.96) L water. In the days preceding the hyponatraemia, patients received 50 (0-189) Na(+), 0 (0-10) K(+), 56 (0-188) Cl(-), and 1.45 (0-2.60) L water. Before the dysnatraemias only 28% of fluid balance charts were completed accurately. During the audit 42% of patients were not weighed. Dysnatraemic patients had a higher hospital mortality rate than those who did not develop dysnatraemia (12.7 vs. 2.3%, P < 0.001).
Four percent of surgical inpatients developed dysnatraemias, which were associated with increased mortality. Fluid balance documentation was suboptimal and daily weights were not measured routinely, even in patients with severe electrolyte derangements.
World Journal of Surgery 03/2010; 34(3):495-9. DOI:10.1007/s00268-009-0374-y · 2.35 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Up to 40% of patients admitted to UK hospitals are malnourished and appropriate nutritional intervention can improve outcomes. We investigated the knowledge and attitudes of UK surgical trainees towards nutritional support and compared their responses with dieticians.
Trainee surgeons and qualified dieticians were asked to complete a multiple choice question test derived from topics relating to nutritional support, followed by a questionnaire on their attitudes towards nutrition. Participants were unaware that they would be tested.
The test was administered to 63 doctors and 25 dieticians. There were 19 newly qualified doctors (foundation year 1 [FY(1)]), 21 junior surgeons (speciality-training years 1 and 2 [ST(1-2)]) and 23 senior surgeons (speciality-training years 3 and above [ST(3+)]). Mean [SE] test scores were lower for doctors compared to dieticians (14.0 [0.64] versus 26.4 [0.22], p<0.001). The respective test scores for FY(1), ST(1-2), ST(3+) doctors were 9.8 [0.78], 14.3 [1.10] and 17.3 [0.76]. Only 47% of doctors felt they had adequate knowledge of this subject and 65% stated that they regularly made decisions on nutritional support. Furthermore, only 25% stated they could calculate daily energy and nutritional requirements.
Despite making decisions related to nutritional support regularly, surgical doctors in the UK demonstrated less knowledge of the fundamental principles of nutritional support than dieticians.