Perioperative risk factors for in-hospital mortality after emergency gastrointestinal surgery

Abstract

Few studies have evaluated the risk factors for in-hospital mortality in critically ill surgical patients who have undergone emergency gastrointestinal (GI) surgery. The aim of this study was to identify the risk factors associated with in-hospital mortality in critically ill surgical patients after emergency GI surgery.The medical records of 362 critically ill surgical patients who underwent emergency GI surgery, admitted to intensive care unit between January 2007 and December 2011, were reviewed retrospectively. Perioperative biochemical and clinical parameters of survivors and nonsurvivors were compared. Logistic regression multivariate analysis was performed to identify the independent risk factors of mortality.The in-hospital mortality rate was 15.2% (55 patients). Multivariate analyses revealed cancer-related perforation (odds ratio [OR] 16.671, 95% confidence interval [CI] 2.629–105.721, P = 0.003), preoperative anemia (hemoglobin <10 g/dL; OR 6.976, 95% CI 1.376–35.360, P = 0.019), and preoperative hypoalbuminemia (albumin <2.7 g/dL; OR 9.954, 95% CI 1.603–61.811, P = 0.014) were independent risk factors of in-hospital mortality after emergency GI surgery.The findings of this study suggest that in critically ill patients undergoing emergency GI surgery, cancer-related peritonitis, preoperative anemia, and preoperative hypoalbuminemia are associated with in-hospital mortality. Recognizing risk factors at an early stage could aid risk stratification and the provision of optimal perioperative care.

Risk factors for mortality after emergency laparotomy: scoping systematic review

“…19,29 Haematology Increased mortality was observed in patients with reduced platelet levels in two studies, inclusive of a large study by Peponis et al 26,29 Likewise, low haemoglobin levels were associated with an increased mortality in one small study (Table S5). 27 Deranged white cell count (WCC) is associated with increased mortality in three studies, inclusive of the two largest studies, by Al-Temimi et al and Peponis et al 19,24,29 Two smaller studies did not show any significant difference in mortality with deranged WCC (Table S5). 25,27 Blood glucose level Two studies investigated the influence of blood glucose level (BGL) on mortality after an EL.…”

“…27 Deranged white cell count (WCC) is associated with increased mortality in three studies, inclusive of the two largest studies, by Al-Temimi et al and Peponis et al 19,24,29 Two smaller studies did not show any significant difference in mortality with deranged WCC (Table S5). 25,27 Blood glucose level Two studies investigated the influence of blood glucose level (BGL) on mortality after an EL. 18,20 One small study, by Awad et al, demonstrated an increase in the 30-day mortality with an increasing BGL, although this result was not statistically significant (Table S5).…”

“…17,19,21 Cancer Four studies, including two large studies by Al-Temimi et al and Peponis et al, showed increased mortality in the setting of disseminated cancer but previous history of cancer was not associated with mortality in one small study, by Wilson et al (Table S4). 17,19,21,27,29 Bleeding Two small studies showed no mortality difference when on warfarin or having deranged activated partial thromboplastin time. 17,18 However, bleeding disorders were associated with increased mortality in the two largest studies (Table S4).…”

“…Five studies, including two large studies by Haskins et al and Peponis et al, showed increased mortality in patients with lower albumin, with one small study on relaparotomies, by Başol et al, showing no difference (Table S5). 15,26,27,29,30,32 Creatinine and blood urea nitrogen Four studies demonstrated that higher blood urea nitrogen (BUN) levels are associated with increased mortality, although this result was not statistically significant in one small study by Awad et al 18,[29][30][31] Another five studies showed increased mortality in patients with higher creatinine levels (Table S5). 19,22,29,31,32 Serum sodium Two large studies showed an increase in 30-day mortality with increased serum sodium levels (Table S5).…”

Gastrointestinal perforations: a tertiary care center experience

“…23 To conclude, proximal bowel is injured much more commonly than distal bowel by perforations. Gastrointestinal perforations show increased morbidity in patients with associated risk factors including smoking, chronic NSAID intake and alcohol abuse.…”