Risk Estimation for Acute Laparotomy
This study is not currently open to accept applicants.
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Emergency Laparotomy Study
This study is open to Females and Males in New Zealand aged 18 to 100
Participants: Adult patients booked acutely for AL from the ward or admitted from the emergency department, including elective patients booked for acute laparotomy for a complication. The target population are acute surgery patients. Inclusion Criteria: Open, laparoscopic, or laparoscopically-assisted procedures Procedures involving the stomach, small or large bowel, or rectum for conditions such as perforation, ischaemia, abdominal abscess, bleeding or obstruction Washout/evacuation of intra-peritoneal abscess (unless due to appendicitis or cholecystitis – excluded, see below) Washout/evacuation of intra-peritoneal haematoma Bowel resection/repair due to incarcerated incisional, umbilical, inguinal and femoral hernias (but not hernia repair without bowel resection/repair). E.g. Large incisional hernia repair with bowel resection Bowel resection/repair due to obstructing/incarcerated incisional hernias provided the presentation and findings were acute. This will include large incisional hernia repair with division of adhesions. Laparotomy/laparoscopy with inoperable pathology (e.g. peritoneal/hepatic metastases) where the intention was to perform a definitive procedure. This does not include purely diagnostic procedures. Laparoscopic/Open Adhesiolysis Return to theatre for repair of substantial dehiscence of major abdominal wound (i.e. “burst abdomen”) If multiple procedures are performed on different anatomical sites within the abdominal/pelvic cavity, the patient would be included if the major procedure is general surgical. E.g. Non-elective colonic resection with hysterectomy for a fistulating colonic cancer would be included as the bowel resection is the major procedure However, bowel resection at the same time as emergency abdominal aortic aneurysm repair would not be included as the aneurysm repair is the major procedure Exclusion Criteria: Patients under 18 Elective laparotomy / laparoscopy With NCEPOD classification: Codes 1 (Immediate) and 4 (elective) are excluded. Diagnostic laparotomy/laparoscopy where no subsequent procedure is performed (NB, if no procedure is performed because of inoperable pathology, then include) Appendicectomy +/- drainage of localised collection unless the procedure is incidental to a non-elective procedure on the GI tract Cholecystectomy +/- drainage of localised collection unless the procedure is incidental to a non-elective procedure on the GI tract Non-elective hernia repair without bowel resection or division of adhesions Minor abdominal wound dehiscence unless this causes bowel complications requiring resection Non-elective formation of a colostomy or ileostomy as either a trephine or a laparoscopic procedure (NB: if a midline laparotomy is performed, with the primary procedure being formation of a stoma then this should be included) Vascular surgery, including abdominal aortic aneurysm repair Caesarean section or obstetric laparotomies Gynaecological laparotomy Ruptured ectopic pregnancy, or pelvic abscesses due to pelvic inflammatory disease Laparotomy/laparoscopy for pathology caused by blunt or penetrating trauma All surgery relating to organ transplantation (including returns to theatre for any reason following transplant surgery) Surgery relating to sclerosing peritonitis Surgery for removal of dialysis catheter
Participants: Adult patients booked acutely for AL from the ward or admitted from the emergency department, including elective patients booked for acute laparotomy for a complication. The target population are acute surgery patients. Inclusion Criteria: Open, laparoscopic, or laparoscopically-assisted procedures Procedures involving the stomach, small or large bowel, or rectum for conditions such as perforation, ischaemia, abdominal abscess, bleeding or obstruction Washout/evacuation of intra-peritoneal abscess (unless due to appendicitis or cholecystitis – excluded, see below) Washout/evacuation of intra-peritoneal haematoma Bowel resection/repair due to incarcerated incisional, umbilical, inguinal and femoral hernias (but not hernia repair without bowel resection/repair). E.g. Large incisional hernia repair with bowel resection Bowel resection/repair due to obstructing/incarcerated incisional hernias provided the presentation and findings were acute. This will include large incisional hernia repair with division of adhesions. Laparotomy/laparoscopy with inoperable pathology (e.g. peritoneal/hepatic metastases) where the intention was to perform a definitive procedure. This does not include purely diagnostic procedures. Laparoscopic/Open Adhesiolysis Return to theatre for repair of substantial dehiscence of major abdominal wound (i.e. “burst abdomen”) If multiple procedures are performed on different anatomical sites within the abdominal/pelvic cavity, the patient would be included if the major procedure is general surgical. E.g. Non-elective colonic resection with hysterectomy for a fistulating colonic cancer would be included as the bowel resection is the major procedure However, bowel resection at the same time as emergency abdominal aortic aneurysm repair would not be included as the aneurysm repair is the major procedure Exclusion Criteria: Patients under 18 Elective laparotomy / laparoscopy With NCEPOD classification: Codes 1 (Immediate) and 4 (elective) are excluded. Diagnostic laparotomy/laparoscopy where no subsequent procedure is performed (NB, if no procedure is performed because of inoperable pathology, then include) Appendicectomy +/- drainage of localised collection unless the procedure is incidental to a non-elective procedure on the GI tract Cholecystectomy +/- drainage of localised collection unless the procedure is incidental to a non-elective procedure on the GI tract Non-elective hernia repair without bowel resection or division of adhesions Minor abdominal wound dehiscence unless this causes bowel complications requiring resection Non-elective formation of a colostomy or ileostomy as either a trephine or a laparoscopic procedure (NB: if a midline laparotomy is performed, with the primary procedure being formation of a stoma then this should be included) Vascular surgery, including abdominal aortic aneurysm repair Caesarean section or obstetric laparotomies Gynaecological laparotomy Ruptured ectopic pregnancy, or pelvic abscesses due to pelvic inflammatory disease Laparotomy/laparoscopy for pathology caused by blunt or penetrating trauma All surgery relating to organ transplantation (including returns to theatre for any reason following transplant surgery) Surgery relating to sclerosing peritonitis Surgery for removal of dialysis catheter