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J Pediatr Surg. 2019 Sep;54(9):1736-1739. doi: 10.1016/j.jpedsurg.2018.11.018. Epub 2019 Apr 25.

Laparotomy complications on extracorporeal life support: Surgical site bleeding does not increase mortality.

Author information

1
Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA; Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, CA.
2
Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, CA.
3
Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA; Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, CA. Electronic address: Dbliss@chla.usc.edu.

Abstract

PURPOSE:

The risks of laparotomy during extracorporeal life support (ECLS) are poorly defined. We examined risk factors associated with bleeding and mortality after laparotomy on ECLS.

METHODS:

The Extracorporeal Life Support Organization (ELSO) database was queried for all pediatric patients [0-17 years] with a procedure code for laparotomy. Outcome data were analyzed to define factors contributing to laparotomy complications and mortality while on ECLS. Univariate and multivariate analyses were applied to determine independent risk factors.

RESULTS:

196 patients who met inclusion criteria were identified. The mortality rate in the entire cohort was 67.3%. In both univariate and multivariate analyses, surgical site bleeding did not significantly increase the risk of mortality (OR 0.8; 95% CI 0.4-1.7). Logistic regression analysis revealed that lower gestational age, infectious complications and nonsurgical site hemorrhagic complications were independently increased mortality risk (all p < 0.05).

CONCLUSION:

Mortality following laparotomy on ECLS is not independently associated with surgical site bleeding, but is associated with lower gestational age, infectious and nonsurgical site hemorrhagic complications.

TYPE OF STUDY:

Retrospective comparative study.

LEVEL OF EVIDENCE:

Level III.

KEYWORDS:

Bleeding; Exploratory laparotomy; Extracorporeal life support; Mortality

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