Effects of surgical treatment on 24465 patients with intestinal perforation complicated with septic shock in tertiary hospitals in China from 2017 to 2020: a systematic review

Abstract

Background Intestinal perforation often leads to abdominal infection and is one of the main causes of septic shock. Prompt surgical treatment is an important treatment for this disease. We designed this study to investigate the effects of surgical treatment on patients with intestinal perforation complicated with septic shock in China. Methods Tertiary hospitals were enrolled from the China National Critical Care Quality Control Center (China-NCCQC). The data were collected between January 1, 2017 and December 31, 2020. Intestinal perforation includes duodenal perforation, jejunal perforation, ileal perforation, colonic perforation, and rectal perforation. Sepsis 3.0 criteria were used for the diagnosis of septic shock. According to the above criteria, 26747 patients from 247915897 patients were selected. After excluding the missing data of gender, age and discharge mode, 24465 patients were remained. Results Patients with intestinal perforation complicated with septic shock in tertiary hospitals in China are more male and older patients. A significant proportion of patients were hospitalized for more than one month. The hospitalization cost per capita of these patients far exceeds the overall hospitalization cost per capita. In the operative group, the hospitalization days were longer. The operative group spent more. However, the incidence of complications was lower in the operative group. Patients with coronary heart disease (CHD) tended to be treated nonoperatively, and patients with systemic lupus erythematosus (SLE) tended to be treated surgically. 20% of the patients discharged against medical advice, 12% of the patients died. The operative group had a higher rate discharging with medical advice and a lower mortality rate. Conclusions For intestinal perforation complicated with septic shock in tertiary hospitals in China, patients who had surgery stayed longer and cost more. However, the incidence of complications was lower in the patients who had surgery. At the same time, the rate of discharging with medical advice was higher and the mortality rate was lower in the patients who had surgery.