Elevated serum lactate as a predictor of outcomes in patients following major abdominal surgery at a tertiary hospital in Uganda

Abstract

Introduction Major abdominal surgery is still a great contributor to postoperative morbidity and mortality in developing countries. Major abdominal surgery leads to hypoperfusion, which has an impact on postoperative morbidity and mortality. Lactate, a biomarker for hypoperfusion is under utilized in Uganda. The study aimed to investigate the association between elevated serum lactate and outcomes (in-hospital mortality, SSI and length of hospital stay) in patients following major abdominal surgery. Methods A prospective observational cohort study was done with 246 eligible patients recruited. Stratified sampling was carried out till desired sample size was achieved. Demographic and perioperative data were collected, serum lactate levels were measured at induction and immediately after surgery with serial measurements being done after 12, 24 h post operatively. Participants were followed up to assess outcomes. Data analysis was done using STATA version 14.0. Results A total of 130 patients (52.8%) had elevated serum lactate levels. Elevated serum lactate predicted in-hospital mortality and surgical site infection. The accuracy of elevated serum lactate to predict mortality with AUROC of 0.7898 was exhibited by the 24 h lactate values. Elevated serum lactate predicted surgical site infection accurately with AUROC 0.6432. Length of hospital is strongly associated with elevated serum lactate with p-value of 0.043. Patients with elevated serum lactate on average have a longer length of hospital stay at 5.34 ± 0.69. Conclusion Elevated serum lactate was associated with in-hospital mortality, surgical site infection and longer length of hospital stay. Serum lactate levels done at 24 h were most predictive of mortality and surgical site infection.

Incidence and predictors of postoperative complications in Sub-Saharan Africa: a systematic review and meta-analysis

“…These include the mechanism of injury, Patient admission path(direct from emergency department to Operating room or Surgical ward/unit), and the process of diagnosis and initial management ( 17 ). Factors like the duration of illness, preoperative diagnoses, and the need for ICU admission were also highlighted ( 19 ) Moreover, the availability of emergency case operating rooms, pre-surgical antibiotics, and essential surgical equipment were crucial considerations ( 20 , 29 ). Issues such as reduced access to advanced imaging techniques, interrupted referral linkages between health facilities, and turnover of trained manpower contribute to deficits in care.…”

Development and validation of a novel nomogram to predict the risk of the prolonged postoperative length of stay for lumbar spinal stenosis patients

“…Excessive blood loss in surgery will reduce organ perfusion, which would impact the oxygenation of tissues. Henry et al [40] pointed out that hypoperfusion after abdominal surgery will increase the morbidity and mortality rate. Thus, it is obvious that blood loss will in uence the procedure of postoperative rehabilitation.…”

Emergent surgical interventions in noncritical traumatic long bone fractures and lactate monitoring: a retrospective cohort study

“…Patients with normal admission lactate may have been triaged as more stable than patients with elevated admission lactate and, therefore, considered as nonurgent surgical candidates 24 , 34 . The association of elevated lactate with increased length of hospital stay has been widely contested, with studies both in support and against this correlation, suggesting that LOS may be dependent on other factors 8 , 17 , 19 , 24 , 35 – 37 . For patients with elevated admission lactate greater than or equal to 2.0 mmol/l, the time lapsed in aggressively resuscitating them with the goal of preoperative lactate normalization did not prolong hospital stay significantly as both groups underwent operative repair within a median 1 day period.…”