February 26, 2024Open Access

Quality of life after emergency laparotomy: a systematic review

Q: What is the clinical evidence from this study?

Study design: Systematic Review. Population: Emergency laparotomy for general or gastrointestinal surgical conditions (n=1542). Intervention: Emergency laparotomy vs. Pre-operative baseline, healthy reference population, or patients without chronic pain. Primary outcome: Postoperative quality of life (QoL) after emergency laparotomy compared with a comparator group.

EKEsha KhanderiaWest Hertfordshire Hospitals NHS Trust RARavi AggarwalThe Alan Turing Institute GBGeorge BourasFlinders University

Key Result

In a systematic review of 1,542 patients, post-operative quality of life was lower in 8 of 11 studies following emergency laparotomy, with length of hospital stay identified as a predictor of poorer QoL.

Study Design

Type

Systematic Review (n=1,542)

Structured PICO

Does emergency laparotomy reduce postoperative quality of life in patients undergoing emergency general surgery?

Population

1,542 patients with an average age of 61.2 years who underwent emergency laparotomy for general or gastrointestinal surgical conditions, pooled from 11 studies to assess post-operative quality of life.

Exposure

Emergency laparotomy (open major abdominal surgery)

Comparator

Comparator group (pre-operative baseline, healthy reference population, or patients without chronic pain)

Outcome

Postoperative QoL after emergency laparotomy when compared with a comparator grouppatient reported

Emergency laparotomy generally reduces post-operative quality of life compared to baseline or healthy populations, with length of hospital stay being a key predictor of poorer QoL.

Limitations

Studies varied in the QoL instruments used, leading to heterogenous data and inconsistency in reporting.
Comparator populations varied between studies.
Length of post-operative follow-up and indications for emergency laparotomy varied.
Prospective studies were of higher quality than the retrospective studies included.
Some QoL instruments had very short-term follow-up of 30 days, which likely skewed results due to lower scores in the immediate post-operative period.
Potential recall bias in studies asking patients to retrospectively report pre-operative QoL.
Variability in response rates to the QoL surveys across studies.

Abstract

BACKGROUND: Emergency laparotomy is a commonly performed surgical procedure that has higher post-operative morbidity and mortality than elective surgery. Previous research has identified that patients valued postoperative quality of life (QoL) more than the risk of mortality when deciding to undergo emergency surgery. Current pre-operative scoring and risk stratification systems for emergency laparotomy do not account for or provide prediction tools for post-operative QoL. This study aims to systematically review previous literature to determine post-operative QoL in patients who undergo emergency laparotomy. METHODS: A literature search was undertaken in Medline, EMBASE and the Cochrane Library to identify studies measuring post-operative QoL in patients who have had emergency laparotomy up to 29th April 2023. Mean QoL scores from the studies included were combined to calculate the average effect of emergency laparotomy on QoL. The primary outcome of the review was postoperative QoL after emergency laparotomy when compared with a comparator group. Secondary outcomes included the quality of included studies. RESULTS: Ten studies in the literature assessing the QoL of patients after emergency laparotomy were identified. Three studies showed that patients had improved QoL and seven showed worse QoL following emergency laparotomy. Length of time for QoL to return to baseline varied ranged from 3 to 12 months post-operatively. Length of hospital stay was identified as an independent risk factor for poorer QoL post-surgery. CONCLUSIONS: Outcome reporting for patients who undergo emergency laparotomy should be expanded further to include QoL. Further work is required to investigate this and elicit factors that can improve QoL post-operatively.

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Cite This Study

Khanderia et al. (Mon,) conducted a systematic review in Emergency laparotomy for general or gastrointestinal surgical conditions (n=1,542). Emergency laparotomy vs. Pre-operative baseline, healthy reference population, or patients without chronic pain was evaluated on Postoperative quality of life (QoL) after emergency laparotomy compared with a comparator group. In a systematic review of 1,542 patients, post-operative quality of life was lower in 8 of 11 studies following emergency laparotomy, with length of hospital stay identified as a predictor of poorer QoL.

synapsesocial.com/papers/6a20b49652a81c8a3de5236b https://doi.org/https://doi.org/10.1186/s12893-024-02337-y

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