Preoperative predictors of morbidity in patients with perforation peritonitis: Can early identification prevent mortality?

Abstract

Introduction: Perforation peritonitis is one of the most frequently encountered surgical emergencies in tropical countries like India and mostly affects young men in their prime of life. In the majority of the cases, presentation to the hospital is late with generalized peritonitis and varying degrees of septicemia. It is therefore necessary to recognize patients at risk preoperatively and prepare for an aggressive management strategy. The present study was thus planned to assess the clinical factors that could predict morbidity and mortality preoperatively in people with perforated peritonitis.  Materials and methods: 100 adult patients above 14 years of age with perforated peritonitis who underwent emergency laparotomy were evaluated. Data on demographics, comorbidities, vital signs, deranged biochemical parameters, delay in presentation to the hospital, and personal medical history were collected and analyzed for preoperative predictors.  Results: Postoperative morbidity and mortality were the key results. The findings revealed that a number of preoperative predictors like advanced age, delay in presentation to the tertiary care center, medical co-morbidities an elevated white blood cell count, and a protracted preoperative hospital stay were strongly linked with greater morbidity and mortality. Among the pre-existing comorbidities, COPD accounted for most of the deaths after surgery.  Conclusion: Early detection of preoperative predictors can assist clinicians in risk stratification by enhancing preoperative care and help in a well-directed therapy for patients who are more likely to experience postoperative difficulties and thus lower morbidity and death. A proper referral mechanism and early transportation along with adequate health education particularly for rural populations can reduce the morbidity and mortality in such patients.