Evaluation and Prediction of the Degree of Severity of Early Postoperative Period in Patients with Acute Surgical Diseases of the Abdominal Cavity, Complicated by Peritonitis
Introduction. While providing surgical care for patients with acute surgical diseases, the course of which is complicated by peritonitis, especially in elderly people, it is extremely important to assess the severity of the disease and the general condition of the patient. This allows prognostication of multi-organ dysfunction syndrome and determines the future treatment tactics as well as disease outcome. Existing health scoring systems (APACHE II, APACHE III, SAPS, MODS, SOFA) cannot satisfy clinical needs, as they require both time and resources. Also, these systems are focused on predicting the disease outcome but not the treatment strategy. The aim of the study is to improve the results of treatment of patients with acute surgical diseases of the abdominal cavity complicated by peritonitis, by improving methods for assessing severity of the patient.
Material and Methods. Clinical study is conducted based on observation of 312 patients with acute surgical diseases of the abdominal cavity, complicated by various forms of peritonitis. The study approved by IRB. We calculated likelihood of complications during the postoperative period in accordance to criteria defined in relation to the status of patients based on scoring systems. The scoring system included modified APACHE II with other criteria, e.g. emergency surgery coefficient, emergency status coefficient, intraabdominal infection and gastrointestinal diseases coefficients. Age and comorbidity were separate factors added to the final score in a form of additional points. The patient’s general condition severity coefficient (GCTC) was calculated for each patient based on clinical studies to predict the severity of postoperative period and prediction of complications. Excel (Microsoft®) and Statistica 7.0 (Statsoft® Inc) software was used for statistical analysis.
Results and Discussion. Retrospectively GCTC was calculated for comparison group, which included 61 patients of the main group and 62 patients with acute surgical diseases of the abdominal cavity. In the main group, serious complications in the early postoperative period, which led to the fatalities, were observed in 5 patients (8.06 %) while the figure rose to 12 patients (19.7 %) in the comparison group. Mortality in the study group was lower by 11.6 % due to the timely determination of GCTC in the early postoperative period and adequate surgical intervention, optimized comprehensive medical treatment according to the developed algorithm of activity.
The proposed prediction system, especially in patients of older age includes following significant prognostic factors: age of the patient; the presence of comorbidities and the extent of their compensation; timely hospitalization in a hospital; interventions in the pre-hospital phase; the severity of patients’ status; violation of physiological parameters that reflect shock and lethal triad (hypothermia, acidosis, coagulopathy); multi-organ dysfunction, signs of systemic inflammatory response syndrome; reversibility indicators of multiple organ dysfunction syndrome during treatment.
In patients with moderate risk of mortality after short-term preoperative preparation traditional volume surgery was performed. In high-risk patients we conducted resuscitation laparotomy, preoperative preparation is minimized. Programmed laparoapertions (programmed laparotomies) were considered for this group of patients because duration of surgery was limited.
Conclusions. There is a risk of severe septic complications in the early postoperative period in patients with acute surgical diseases of the abdomen. Application of the developed methodology for assessing the severity of early postoperative period in patients with acute abdomen in different age groups will help in minimizing the number of complications and mortality due to timely prediction and treatment tactics correction.
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