COVID-19, Emergency General Surgery
Conditions
Brief summary
NLR has previously been observed to correlate with complications in upper GI (1) and colorectal (2) surgery. The investigators sought to assess if a similar correlation can be identified in emergency general surgical patients and if the presence of suspected or confirmed COVID-19 may impact on this. Given the heterogeneity of emergency general surgery the investigators therefore plan to perform a retrospective review of patients having emergency laparotomies only at a single NHS site during COVID-19 pandemic. Assessment of outcomes and Neutrophil:lymphocyte ratio as a predictor of outcomes will be completed. Outcomes will be completed in line with the recent COVIDSurg study criteria (3). The primary outcome is 30-day mortality. Secondary outcomes are 7-day mortality, re-operation, length of stay, post-operative respiratory failure, post-operative ARDS (Acute Respiratory Distress Syndrome), post-operative sepsis and ITU (Intensive Therapy Unit)/HDU (High Dependency Unit) admission.
Interventions
PROCEDUREEmergency Laparotomy
All adult patients undergoing emergency laparotomy
Sponsors
Barking, Havering and Redbridge University Hospitals NHS Trust
Study design
Observational model
COHORT
Time perspective
RETROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* Patients undergoing emergency laparotomy (change made due to heterogeneity of emergency general surgery)
Exclusion criteria
* Inherited or acquired immunodeficiency (which may directly skew NLR)
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| 30-day mortality | 30 days | Mortality |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Length of stay | 30 days | Inpatient stay during index admission |
| Post-operative respiratory failure | 30 days | Presence of respiratory failure in the post-operative period as defined in the clinical notes or discharge summaries |
| Post-operative ARDS | 30 days | ARDS diagnosed radiologically |
| Post-operative sepsis | 30 days | Presence of sepsis in the post-operative period as defined in the clinical notes or discharge summaries |
| ITU/HDU admission | 30 days | ITU/HDU admission post-operatively |
| 7-day mortality | 7 days | Mortality |
| Number of participants returning to theatre | 30 days | Re-operation |
Other
| Measure | Time frame | Description |
|---|---|---|
| Post-operative platelet counts | First 3 post-operative days | Absolute platelet counts recorded daily in the peri-operative period |
| Post-operative coagulopathy | First 3 post-operative days | Defined as the presence of increased PT (prothrombin time) OR APTT (activated partial thromboplastin time) OR TT (thrombin time) OR fibrinogen above 1.5X the upper limit of normal. Coagulation will either be defined as normal or abnormal for each patient if one or more of these derangement are identified. |
| Other complications | 30 days | Other documented post-operative complications |
| Peri-operative NLR | First 3 post-operative days | Neutrophil:Lymphocyte Ratio will be recorded daily in the peri-operative period |
Countries
United Kingdom
Outcome results
None listed