Predictors of Morbidity and Mortality After Surgery for Intestinal Perforation

Shin, Rumi; Lee, Sang Mok; Sohn, Beonghoon; Lee, Dong Woon; Song, In‐Ho; Chai, Young Jun; Lee, Hae Won; Ahn, Hye Young; Jung, In Mok; Chung, Jung Kee; Heo, Seung Chul

doi:10.3393/ac.2016.32.6.221

Cited by 50 publications

(46 citation statements)

References 34 publications

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“…In our study, there was a total of 10.8% mortality noted amongst subjects which was statistically significantly associated with POMPP score. This observation was fairly comparable to past study by Shin et al had who noted 12.8% mortality in 117 patients who underwent surgery for an intestinal perforation [13]. Additionally, mortality in study by Kemparaj et al [14%] was higher than our overall mortality whereas that noted in Bali et al was lower [7%].…”

Section: Methodssupporting

confidence: 91%

Prediction of mortality and morbidity in patients with secondary peritonitis using POMPP scoring

2020

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Introduction "POMPP [Practical scoring system of mortality in patients with perforated peptic ulcer] is a simple, clinically applicable scoring system that may allow surgeons to rapidly predict mortality rates in patients based on objective data." This study was aimed at using the POMPP scoring in secondary peritonitis patients for rapid assessment, to predict the mortality and morbidity and to validate POMPP scoring. Methodology This observational study was conducted on patients with suspected secondary peritonitis at the Himalayan Institute of Medical Sciences, Dehradun over a period of 12 months from January 2017 to December 2017. All patients fulfilling inclusion criteria were included with written informed consent. The parameters under evaluation for each patient under the POMPP scoring were Age [> 65 years], serum albumin [< 1.5gm/dl] and blood urea nitrogen [> 45 mg/dl], with each parameter having a score of 1. Risk of mortality and complications associated with POMPP score were analysed using statistical tests including chi square test, student t test and Fisher exact test. A p value < 0.05 was considered statistically significant. Results During the study period a total of 138 patients undergoing laparotomy for peritonitis were enrolled and evaluated. There were 86 [62.3%], 42 [30.4%], 9 [6.5%] and 1 [0.7%] patients with scores of 0, 1, 2 and 3, respectively. Additionally, the postoperative complications were broadly divided into local, respiratory, renal, cardiovascular, systemic and anastomotic complications. Local Complications were found to be most common with 38 [27.5%] patients. Study of mortality associated with each score revealed there was 3.5% mortality with score 0, 16.7% with score 1, 44.4% with score 2, 100% with score 3 thus indicating that the gravest prognosis lies with patients who present with a POMPP score of 3. However, there was only one patient who had POMPP score 3. This observation of increasing POMPP score with relation to mortality was deemed statistically significant [p<0.05] using Fisher's exact test. Conclusions Gastrointestinal perforation and secondary peritonitis patients have been shown to have a strong association with advanced age, blood urea nitrogen and serum albumin levels. Analysis of these simple clinical and biochemical parameters in our study has helped in validation of the POMPP scoring system for risk stratification of cases of secondary peritonitis. It has been observed to be a simple, clinically applicable scoring system that may allow surgeons to rapidly predict morbidity and mortality rates in all types of gastrointestinal perforations.

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Section: Methodssupporting

confidence: 91%

Prediction of mortality and morbidity in patients with secondary peritonitis using POMPP scoring

2020

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“…There are several studies about the prognostic factors associated with mortality of colonic perforation. Each study showed that the mortality of patients was associated with factors including but not limited to serum albumin level, C-reactive protein level, acute renal failure, Mannheim Peritoneal Index, and American Society of Anesthesiologists physical status classification system score [2,[11][12][13][14]. Scoring systems such as POSSUM, P-POSSUM, CR-POS-SUM, Association of Coloproctology of Great Britain & Ireland mortality model were developed to assess the prognosis of colonic perforation.…”

Section: Discussionmentioning

confidence: 99%

Prognostic Factors and Management for Left Colonic Perforation: Can Hartmann’s Procedure Be Preventable?

et al. 2020

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Purpose: To identify factors significantly associated with the mortality of patients with left colonic perforation, and to compare the outcome of Hartmann’s procedure (HP) and primary repair (PR) or primary anastomosis (PA) in patients with left colonic perforation without factors associated with mortality.Methods: This retrospective study included patients who underwent surgery for left colonic perforation from January 2009 to February 2018. Preoperative factors related to postoperative mortality, including vital signs, laboratory findings, and intraoperative findings, were analyzed by type of operation. The chi-square, Fisher exact, and Mann-Whitney U-tests were used to analyze the data.Results: Ninety-one patients were included (36 men, 55 women), and 15 (16.5%) died postoperatively. Prognostic factors were age, leukopenia, thrombocytopenia, bleeding tendency, acute kidney injury, hemodynamic instability, and the existence of feculent ascites. Leukopenia and longer operative time were independent risk factors for mortality. Seventy-nine patients did not have leukopenia and 30 of these patients who underwent PR without diversion were excluded from the subanalysis. HP was performed in 30 patients, and PR with diversion and PA with or without diversion were performed in 19. Compared to the other operative methods, HP had no advantage in reducing hospital mortality (P=0.458) and morbidity.Conclusion: Leukopenia could be an objective prognostic factor for left colonic perforation. Although HP is the gold standard for septic left colonic perforation, it did not improve the hospital mortality of the patients without leukopenia. For such patients, PR or PA may be suggested as an alternative option for left colonic perforation.

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“…A meta-analysis done by Shin K.Y. et al that included 739 patients showed that obesity is associated with more severe course of the disease, systemic complications, local complications and higher mortality rate than other groups (27).…”

Section: Discussionmentioning

confidence: 99%

Ideal Predictors for the Severity of Acute Pancreatitis: A single center Egyptian study

Sobh¹,

Resident²,

Professor³

2016

IJMSCI

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Background & Aims: The ideal predictor of acute pancreatitis should be inexpensive, readily available in most emergency departments, easily applicable, consistent, non-invasive and has the statistical power. Although such predictor has not been detected, the research continues to pursue such one. This survey was created to research and evaluate different simple laboratory tests as possible predictors of severe acute pancreatitis. Materials and Methods: The study population consists of 40 patients admitted to the gastroenterology and Hepatology unit, Tanta University emergency hospital after being diagnosed to have acute pancreatitis. The following data were collected from all patients within 24 hours of admission: Age, sex, complete blood count, body mass index, blood glucose level, serum creatinine, blood urea nitrogen, total bilirubin, aspartate aminotransferase, C-reactive protein, total serum calcium, serum lipase and amylase, arterial blood gases, abdominal ultrasonography and chest X-ray. Results: The study population consisted of 17 males and 23 females. The patients were being divided into two groups: group 1 that included 28 patients diagnosed as mild acute pancreatitis and group 2 that included 12 patients diagnosed as moderate to severe acute pancreatitis. Blood glucose, BUN, AST, CRP, serum lipase, BMI, hematocrit value, leukocytes and platelets count showed significant P value on comparing the two groups. Area under the curve (AUC) had been calculated for the above mentioned possible predictors and it represents the overall accuracy of all points. Blood glucose, AST and platelets count showed the highest AUC, sensitivity, specificity, PPV, NPV and accuracy among other proposed predictors, However, other proposed predictors showed high NPV. Conclusion: Blood glucose level, AST and platelets count showed the highest AUC, sensitivity, specificity, PPV, NPV and accuracy among other proposed predictors. Although other proposed predictors showed lower results than the above mentioned predictors, they still have a very significant NPV and can be used to rule out severe acute pancreatitis.

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Predictors of Morbidity and Mortality After Surgery for Intestinal Perforation

Cited by 50 publications

References 34 publications

Prediction of mortality and morbidity in patients with secondary peritonitis using POMPP scoring

Prediction of mortality and morbidity in patients with secondary peritonitis using POMPP scoring

Prognostic Factors and Management for Left Colonic Perforation: Can Hartmann’s Procedure Be Preventable?

Ideal Predictors for the Severity of Acute Pancreatitis: A single center Egyptian study

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