Predicting quality of life after emergency laparotomy

Abstract text (incl. references and figure legends)

Introduction

Emergency Laparotomy is a common procedure associated with high mortality. Many tools have been developed to predict mortality and are now routinely used in the pre-operative phase to aid shared decision making. Post survival quality of life is very important to patients but more difficult to quantify. This study investigated whether post-operative quality of life can be predicted using commonly available pre-operative variables. The aim is to present better information to patients to allow more nuanced decision making.

Materials and Methods

Patients undergoing emergency laparotomy at our institution are prospectively entered into an online databse for the National Emergency Laparotomy Audit (NELA). All NELA-registered patients are offered follow up with a nurse specialist who completes the EQ-5D-5L and SF-12 Quality of Life (QoL) questionnaires. Spearman's coefficients were calculated to identify correlation between pre-operative characteristics and their subsequent responses to the QoL questionnaires. Mann-Whitney U tests were performed to compare the responses of patients in groups found to have either good or poor post operative quality of life.

Results

407 patients were prospectively entered into the NELA database between 03/05/2019 and 30/12/2020. 375 (92%) survived to discharge with 30 and 90 day mortality rates of 4% and 8% respectively. 65% (244) of survivors were followed up in the dedicated clinic and completed QoL questionnaires. Mean time to follow up was 321 days (59-404 days). Survivors had a lower QoL than expected for the general population. QoL is inversely correlated to: NELA predicted Mortality, ASA grade and Clinical Frailty Score (CFS). The following groups are predictative of poor QoL in survivors: NELA-predicted Mortality ≥5%, ASA≥3 CFS ≥2

Conclusions

Risk of poor QoL can be ascertained preoperatively in emergency laparotomy patients and should be included in the consent process.

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