TITLE:
Postoperative Outcomes in Exploratory Laparotomy and Intestinal Resection in Children: A Secondary Descriptive Observational Analysis
AUTHORS:
Claudine Kumba
KEYWORDS:
Exploratory Laparotomy, Intestinal Resection, Children, Intraoperative and Postoperative Outcomes, Intraoperative Goal-Directed Therapies
JOURNAL NAME:
Open Journal of Pediatrics,
Vol.11 No.4,
November
17,
2021
ABSTRACT: Background: We previously reported independent predictors of
intraoperative and postoperative morbidity. These were age, American Society of
Anesthesiologists Score (ASA), emergency situations, surgery and transfusion.
ASA was the independent predictor of mortality. We conducted a secondary
analysis of this previous retrospective study in patients who underwent
exploratory laparotomy and intestinal resection. Objectives: The objective was to describe
intraoperative and postoperative outcomes in patients who underwent exploratory
laparotomy and intestinal resection in the initial study and to present a
research protocol for intraoperative and postoperative optimization. Methods: Secondary analysis of the initial study was used. The Ethics Committee
approved the study. Results: There were 54 patients with a median age of
15.5 [0 - 172] months. Thirty-seven (68.5%) patients underwent
intestinal resection, nine (16.7%) underwent exploratory laparotomy, and eight (16.8%)
underwent laparotomy for volvulus. Fourteen (25.9%) patients had intraoperative
and/or postoperative complications. Two (3.7%) patients had an intraoperative
hemorrhagic shock. Two (3.7%) patients had a postoperative cardio-circulatory
failure. Three (5.6%) had postoperative respiratory failure. One (1.8%) patient
had postoperative multiple organ failure and neurologic failure. Three (5.6%)
patients had postoperative abdominal sepsis. One (1.8%) patient had
postoperative multiple organ sepsis and neuromeningeal sepsis. Four (7.4%)
patients had postoperative pulmonary sepsis. Two (3.7%) had postoperative
septicemia. Six (11.1%) patients had reoperations. Seventeen (31.5%) patients
had an intraoperative transfusion. The in-hospital mortality rate was 3.7% in
two patients. Conclusion: The number of patients with postoperative
complications in this cohort was not negligible. We, therefore, elaborated a
research protocol where intraoperative patient management will be guided with
transthoracic echocardiography for fluid and hemodynamic therapy optimization.
The objective of this study protocol is to clarify the impact of intraoperative
goal-directed fluid and hemodynamic therapy with transthoracic echocardiography
on postoperative outcomes in terms of complications in pediatric surgical
patients.