Predictors of Postoperative Outcome in Emergency Laparotomy for Perforation Peritonitis; a Retrospective Cross-sectional Study
学术急诊医学档案,
卷 10 编号 1 (2022),
1 一月 2022
,
第 e86 页
https://doi.org/10.22037/aaem.v10i1.1827
摘要
Introduction: Hollow viscus perforation is a significant cause of surgical mortality. Various attempts have been made to identify high-risk patients preoperatively and optimize and manage such patients more aggressively. This study aimed to evaluate the predictors of outcome in patients undergoing emergency laparotomy for perforation peritonitis.
Methods: This retrospective cross-sectional study was conducted on perforation peritonitis cases admitted to the Department of General Surgery, All India Institute of Medical Sciences, Rishikesh, India. The association between preoperative patient variables with postoperative complications, anastomotic leaks, need for intensive care unit (ICU) admission, and 30-day mortality were evaluated.
Results: Tachycardia at the time of admission (t = 2.443, p = 0.020), hypotension (χ2 = 18.214, p = <0.001), lower haemoglobin (t = -4.134, p = <0.001), higher blood urea nitrogen levels (W = 1967.000, p = 0.012), International Normalised Ratio (INR) ≥ 1.5 (χ2 = 17.340, p = <0.001), the mean albumin level 2.89 ± 0.77 g/dL (t = -2.348, p = 0.027), and delay in surgery (χ2 = 28.423, p = 0.008) were significant associate factors of mortality. The association between need for ICU admission and higher pulse rate on admission (W = 2782.500, p = 0.011), lower systolic blood pressure (W = 1627.500, p = 0.029), higher blood urea nitrogen (W = 2299.000, p = 0.030) and serum creatinine levels (W = 2192.500, p = 0.045), preoperative coagulopathy (χ2 = 6.773, p = 0.017), hypoalbuminemia (t = -2.515, p = 0.016), and delay in surgery (χ2 = 17.780, p = 0.016) was significant.
Conclusion: Based on the results of this study, hypotension, azotaemia, coagulopathy, and delay in surgery, increase the risk of postoperative mortality of patients undergoing emergency laparotomy for perforation peritonitis. Tachycardia, hypotension, azotaemia, hypoalbuminemia, and pre-operative coagulopathy were good predictors of need for ICU admission. Shock at presentation, deranged renal function and coagulopathy were associated with an increased risk of postoperative complications.
- Emergencies
- intestinal perforation
- mortality
- peritonitis
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参考
Meshram S, Lal M. Clinico-bacteriological profile of non-traumatic perforation peritonitis cases attending a tertiary care hospital of central India region. Int Surg J. 2018;5(6):2185.
Nyström PO, Bax R, Dellinger EP, Dominioni L, Knaus WA, Meakins JL, et al. Proposed definitions for diagnosis, severity scoring, stratification, and outcome for trials on intraabdominal infection. Joint Working Party of SIS North America and Europe. World J Surg. 1990;14(2):148-58.
Billing A, Fröhlich D, Schildberg FW. Prediction of outcome using the Mannheim peritonitis index in 2003 patients. Peritonitis Study Group. Br J Surg. 1994;81(2):209-13.
Bohnen J, Boulanger M, Meakins JL, McLean AP. Prognosis in generalized peritonitis. Relation to cause and risk factors. Arch Surg. 1983;118(3):285-90.
Knaus WA, Le Gall JR, Wagner DP, Draper EA, Loirat P, Campos RA, et al. A comparison of intensive care in the U.S.A. and France. Lancet. 1982;2(8299):642-6.
Meakins JL, Solomkin JS, Allo MD, Dellinger EP, Howard RJ, Simmons RL. A proposed classification of intra-abdominal infections. Stratification of etiology and risk for future therapeutic trials. Arch Surg. 1984;119(12):1372-8.
Singh R, Kumar N, Bhattacharya A, Vajifdar H. Preoperative predictors of mortality in adult patients with perforation peritonitis. Indian J Crit Care Med. 2011;15(3):157-63.
Moons KG, Altman DG, Reitsma JB, Ioannidis JP, Macaskill P, Steyerberg EW, et al. Transparent Reporting of a multivariable prediction model for Individual Prognosis or Diagnosis (TRIPOD): explanation and elaboration. Ann Intern Med. 2015;162(1):W1-73.
Clavien PA, Strasberg SM. Severity grading of surgical complications. Ann Surg. 2009;250(2):197-8.
Jhobta RS, Attri AK, Kaushik R, Sharma R, Jhobta A. Spectrum of perforation peritonitis in India--review of 504 consecutive cases. World J Emerg Surg. 2006;1:26.
Lemeshow S, W. HD, Klar J, Lwanga SK. Adequacy of Sample Size in Health Studies: World Health Organization; 1990. 1-4 p.
IBM. IBM SPSS Statistics for Windows. 23 ed. Armonk, New York: IBM Corp.; 2015.
Leung JM, Dzankic S. Relative importance of preoperative health status versus intraoperative factors in predicting postoperative adverse outcomes in geriatric surgical patients. J Am Geriatr Soc. 2001;49(8):1080-5.
Langell JT, Mulvihill SJ. Gastrointestinal perforation and the acute abdomen. Med Clin North Am. 2008;92(3):599-625, viii-ix.
Peters EG, Dekkers M, van Leeuwen-Hilbers FW, Daams F, Hulsewé KWE, de Jonge WJ, et al. Relation between postoperative ileus and anastomotic leakage after colorectal resection: a post hoc analysis of a prospective randomized controlled trial. Colorectal Dis. 2017;19(7):667-74.
Calin MD, Bălălău C, Popa F, Voiculescu S, Scăunașu RV. Colic anastomotic leakage risk factors. J Med Life. 2013;6(4):420-3.
McDermott FD, Heeney A, Kelly ME, Steele RJ, Carlson GL, Winter DC. Systematic review of preoperative, intraoperative and postoperative risk factors for colorectal anastomotic leaks. Br J Surg. 2015;102(5):462-79.
Oheneh-Yeboah M. Postoperative complications after surgery for typhoid ileal perforation in adults in Kumasi. West Afr J Med. 2007;26(1):32-6.
Gupta S, Kaushik R, Sharma R, Attri A. The management of large perforations of duodenal ulcers. BMC Surgery. 2005;5(1):15.
Wesselink EM, Kappen TH, Torn HM, Slooter AJC, van Klei WA. Intraoperative hypotension and the risk of postoperative adverse outcomes: a systematic review. Br J Anaesth. 2018;121(4):706-21.
Doklestić SK, Bajec DD, Djukić RV, Bumbaširević V, Detanac AD, Detanac SD, et al. Secondary peritonitis - evaluation of 204 cases and literature review. J Med Life. 2014;7(2):132-8.
Nakamura F, Yui R, Muratsu A, Sakuramoto K, Muroya T, Ikegawa H, et al. Study of the prognostic factor of the colon perforation case with the pan-peritonitis that needed emergency surgery: a single-center observational study. Acute Med Surg. 2019;6(4):379-84.
Mulari K, Leppäniemi A. Severe secondary peritonitis following gastrointestinal tract perforation. Scand J Surg. 2004;93(3):204-8.
Reith HB, Mittelkötter U, Wagner R, Thiede A. Procalcitonin (PCT) in patients with abdominal sepsis. Intensive Care Med. 2000;26 (Suppl 2):S165-9.
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