Palaniraj, S (2023) Significance of 24 hour Post Operative Lactate Levels in Predicting Mortality and Morbidity in Patients Undergoing Emergency Laparotomy in a Tertiary Centre. Masters thesis, Madras Medical College, Chennai.
Full text not available from this repository.Abstract
INTRODUCTION: Serum lactate levels had shown to increase in acute abdominal conditions like appendicitis and mesenteric ischemia and can used as a marker for mesenteric ischemia and appendicitis. Blood lactate levels had shown to have greater prognostic value than oxygen derived variables like oxygen delivery or oxygen uptake. Obtaining a lactate level is essential to identifying tissue hypo perfusion in patients who are not yet hypotensive but who are at risk for septic shock. The strategy of clearing lactate to normal values was assessed in the 2012 Surviving Sepsis Campaign Guidelines. The campaign suggests targeting resuscitation to normalize lactate in patients with elevated lactate levels as a marker of tissue hypo perfusion. Lactate clearance is percentage change in lactate level since admission. High lactate clearance to be associated with better outcome in critically ill patients and low mortality in comparison to low lactate clearance. OBJECTIVES : Primary objective: to compare the ability of the lactate levels to predict postoperative mortality. Secondary objective: to compare the ability to predict postoperative morbidity like wound site infection, length of stay, lower respiratory tract infection, inotropic support, development of AKI, delirium, cardiac morbidity and need for re-exploration. METHODOLOGY : The study is done after obtaining a detailed history, complete general physical examination and systemic examination. The patients are subjected to relevant investigations like x-ray erect abdomen, CXR, USG , CT and routine investigations like Hb, TC, urea, creatinine, serum electrolytes. All investigations and surgical procedures were carried out with proper informed written consent as appropriately. Both Preoperative and Postoperative serum lactate analysis will be done, and the outcome analysis will be evaluated with mortality being the primary outcome. Patients will be followed upto 30 days postoperatively. They will be enquired about survival and complications through telephonic interview. The data regarding patient particulars, diagnosis, investigations, and surgical procedures is collected in a specially designed case recording form and transferred to a master chart subjected to statistical methods like mean, standard deviation, proportion, percentage calculation and wherever necessary chi square test for proportion are used. RESULTS: In the present study, 200 case of patients undergoing emergency abdominal surgeries for various etiology who came to RGGGH emergency department from November 2021 to August 2022 were included. Those patients who were more than 12 years of age were included in this study. There is a significant male preponderance (69.39%). Among those included in the study, 24.5% of patients were found to be hypertensive, 32% of patients were found to be diabetic and 9% of the patients were found to be CAD. Various etiologies including Intestinal obstruction, Perforation, SMA thrombosis, Appendicular perforations has been observed in this study. Based on the above values, both observed and expected values are calculated and entered in tables. By using the values, the Chi Square statistic is calculated. Degree of freedom is found to be 1. Based on the analysis, p-value is calculated to find the significance of the test. Based on the analysis of lactate values for patients with complications and without complications, the following observations are made Chi-square statistic is 18.3911. The p-value is 0.000018. Based on the analysis of lactate values for patients with mortality and without mortality, the following observations are made. Chi-square statistic is 6.4068. The p-value is 0.011369. Significant at p < 0.5 CONCLUSION: Sepsis and septic shock remains a major challenge faced by surgeons in current days scenario. Lactate has been proven as an incredible tool to assess the outcomes of the patient and plan the management accordingly. Increased lactate levels post operatively poses significant high risk in mortality and morbidity of the patient and might help surgeons to as a guide to understand the nature of the disease and its prognosis. Those with normal post operative lactate levels are found to have lower risk of complications and mortality.
| Item Type: | Thesis (Masters) |
|---|---|
| Additional Information: | 220120100512 |
| Uncontrolled Keywords: | Significance, 24 hour Post Operative Lactate Levels, Predicting Mortality, Morbidity, Patients Undergoing Emergency Laparotomy, Tertiary Centre. |
| Subjects: | MEDICAL > General Surgery > MEDICAL > General Surgery |
| Depositing User: | Subramani R |
| Date Deposited: | 15 Jan 2024 06:38 |
| Last Modified: | 19 Jan 2024 16:45 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/21302 |
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