Risk factors for mortality after emergency laparotomy: scoping systematic review

BACKGROUND

Emergency laparotomy (EL) is a common procedure with high mortality leading to several efforts to record and reduce mortality. Risk scores currently used by quality improvement programmes either require intraoperative data or are not specific to EL. To be of utility to clinicians/patients, estimation of preoperative risk of mortality is important. We aimed to explore individual preoperative risk factors that might be of use in developing a preoperative mortality risk score.

METHODS

Two independent reviewers identified relevant articles from searches of MEDLINE, EMBASE and Cochrane databases from January 1980 to January 2018. We selected studies that evaluated only preoperative predictive factors for mortality in EL patients.

RESULTS

The search yielded 6648 articles screened, with 22 studies included examining 157 728 patients. The combined post-operative 30-day mortality was 13%. All, but one small study, were at low risk of bias. A meta-analysis of results was not possible due to the heterogeneity of populations and outcomes. Age, American Society of Anesthesiologists, preoperative sepsis, dependency status, current cancer and comorbidities were associated with increased mortality. Acute physiological derangements seen in renal, albumin and complete blood count assays were strongly associated with mortality. Delay to surgery and diabetes did not influence mortality. Higher body mass index was protective.

CONCLUSION

Preoperatively, risk factors identified can be used to develop and update risk scores specific for EL mortality. This scoping review focused on the preoperative setting which helps tailor treatment decisions. It highlights the need for further research to test the relevance of newer risk factors such as frailty and nutrition.

Individualised follow-up booklets improve recall and satisfaction for cancer patients

AIMS

The New Zealand Provisional Standards of Service Provision for Cancer recommend providing patients with written information about their diagnosis, treatment and follow up. This project aimed to develop and evaluate a resource that could be used to provide essential information to patients who were nearing completion of the surgical treatment of their cancer.

METHODS

The study compared patients with melanoma, colorectal and breast cancers who received standard discussion of their diagnosis, treatment and follow-up plan with cancer patients who received a discussion supported by an individualised follow-up booklet. Patients were interviewed using an over-the-phone questionnaire to assess their free recall and prompted recall of follow-up items, their perception of the level of information received and satisfaction with the communication of their follow-up plan.

RESULTS

The group who received a booklet as part of discussion of their follow-up plan scored significantly higher on measures of free recall, prompted recall, satisfaction with the level of information provided and overall satisfaction than those who had a standard clinic discussion but did not receive a booklet. Free recall of two relevant items improved from 61% of patients to 91%. Prompted recall of at least one item improved from 77% of patients to 100%. The proportion of patients feeling they did not receive enough information fell from 25% to 5%. The proportion of patients scoring their satisfaction at >8/10 increased from 68% to 87%. All of these measures reached significance.

CONCLUSION

Individualised cancer follow-up booklets are a simple, low-cost and low-risk initiative that used in a New Zealand setting, was associated with improved patient recall and satisfaction with the follow-up information they received. This supports the benefit of providing participants with personalised written information, as recommended in the New Zealand Provisional Standards of Service Provision for Cancer.