Evidence map›Paper›PMID 33225391›Full record

ArticleWorld journal of surgery2021

Indications and Outcomes for Non-Trauma Emergency Laparotomy: A Comparison of Rwanda, South Africa, and the USA.

Jennifer Rickard, Linda Pohl, Egide Abahuje, Nazmie Kariem, Surita Englbrecht, Christo Kloppers, Sekoaere Malatji, Isaie Sibomana, Alexandria J Robbins, Kathryn Chu

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Article in World journal of surgery, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
1.7field-weighted citation impact, top 14% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

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Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed, 10 citations in OpenAlex.

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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

10 authors at 6 institutions in 3 countries.

Jennifer RickardDepartment of Surgery, University Teaching Hospital of Kigali, Kigali, Rwanda. gehr0059@umn.edu.
Linda PohlDepartment of Surgery, University of Cape Town, Cape Town, South Africa.
Egide AbahujeDepartment of Surgery, University Teaching Hospital of Kigali, Kigali, Rwanda.
Nazmie KariemDepartment of Surgery, University of Cape Town, Cape Town, South Africa.
Surita EnglbrechtDepartment of Surgery, University of Cape Town, Cape Town, South Africa.
Christo KloppersDepartment of Surgery, University of Cape Town, Cape Town, South Africa.
Sekoaere MalatjiDepartment of Surgery, New Somerset Hospital, Cape Town, South Africa.
Isaie SibomanaDepartment of Surgery, University of Rwanda, Kigali, Rwanda.
Alexandria J RobbinsDepartment of Surgery, University of Minnesota, 420 Delaware St SE, MMC 195, Minneapolis, MN, 55455, USA.
Kathryn ChuDepartment of Surgery, University of Cape Town, Cape Town, South Africa.
University of Cape Town · ZAUniversity of Minnesota · USCentre Hospitalier Universitaire de Kigali · RWSomerset Hospital · ZAUniversity of Kigali · RWWestern Cape Department of Health · ZA

Funding

University of Minnesota Clinical and Translational Science Institute (UMN CTSI)UL1TR002494 · NCATS · UNIVERSITY OF MINNESOTA · PI BLAZAR, BRUCE R, WEISDORF, DANIEL J · 2018 to 2022
$34.9M
NIH HHS UL1TR002494
6 · The paper itself

Abstract

backgroundEmergency conditions requiring exploratory laparotomy (EL) can be challenging. The objective of this study is to describe indications, outcomes, and risk factors for perioperative mortality (POMR) after non-trauma EL.

methodsThis was a prospective study of patients undergoing non-trauma EL at four hospitals in Rwanda, South Africa, and the USA. Multivariate logistic regression was used to determine factors associated with POMR.

resultsOver one year, there were 632 EL with the most common indications appendicitis (n = 133, 21%), peptic ulcer disease (PUD) (n = 101, 16%), and hernia (n = 74, 12%). In Rwanda, the most common indications were appendicitis (n = 41, 19%) and hernia (n = 37, 17%); in South Africa appendicitis (n = 91, 28%) and PUD (n = 60, 19%); and in the USA, PUD (n = 16, 19%) and adhesions from small bowel obstruction (n = 16, 19%). POMR was 11%, with no difference between countries (Rwanda 7%, South Africa 12%, US 16%, p = 0.173). Risk factors associated with increased odds of POMR included typhoid intestinal perforation (adjusted odds ratio (aOR): 16.48; 95% confidence interval (CI): 4.31, 62.98; p value < 0.001), mesenteric ischemia (aOR: 13.77, 95% CI: 4.21, 45.08, p value < 0.001), cancer (aOR: 5.84, 95% CI: 2.43, 14.05, p value < 0.001), other diagnoses (aOR: 3.97, 95% CI: 3.03, 5.20, p value < 0.001), high ASA score (score ≥ 3) (aOR: 3.95, 95% CI: 3.03, 5.15, p value < 0.001), peptic ulcer disease (aOR: 2.82, 95% CI: 1.64, 4.85, p value < 0.001), age > 60 years (aOR: 2.32, 95% CI: 1.41, 3.83, p value = 0.001), and ICU admission (aOR: 2.23, 95% CI: 1.24, 3.99, p value = 0.007). Surgery in the US was associated with decreased odds of POMR (aOR: 0.41, 95% CI: 0.21, 0.80, p value = 0.009).

conclusionsIndications for EL vary between countries and POMR is high. Differences in mortality were associated with patient and disease characteristics with certain diagnoses associated with increased risk of mortality. Understanding the risk factors and outcomes for patients with EL can assist providers in judicious patient selection, both for patient counselling and resource allocation.

Indexed as

EmergenciesLaparotomyHumansMiddle AgedProspective StudiesRisk FactorsRwandaSouth Africa

Identifiers

PMID33225391
OpenAlexW3107010558

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.