Grynchuk, Grynchuk, and Polianskiy: Prediction of Postoperative Complications in Acute Peritonitis



Problem statement and analysis of the recent research

The ability to predict the possibility of postoperative complications (POC) is an important component of treatment of acute peritonitis which allows us to use appropriate preventive measures [1, 2]. Numerous methods which are based on the consideration of various parameters have been developed [3, 4, 5]. However, none of them is fully accepted due to a large number of parameters that determines the complexity of their using and low informative value of the methods which are based on a small number of criteria, etc. The Mannheim peritonitis index (MPI) is acknowledged in many countries [6], however, its only function is the determination of the severity of peritonitis. It is clear, that the increase in peritonitis severity and severity of the patient’s condition results in an increased likelihood of postoperative complications; the aforementioned methods, however, do not allow differentiating the risk of separate postoperative complications.

The objective of the research was to develop an informative method for predicting postoperative complications.

Materials and methods

A retrospective analysis of the results of treating 169 patients with different forms of peritonitis was made. The age of patients ranged from 17 to 84 years. There were 98 males and 71 females. 45 patients were diagnosed with localized peritonitis; 53 patients were diagnosed with diffuse peritonitis; in 57 patients generalized peritonitis was found; in 13 patients general peritonitis was observed. 79 patients developed postoperative complications: 24 cases of inflammation and wound abscess, 5 cases of eventrations, 14 cases of intra-abdominal abscesses and infiltrates, 18 cases of the failure of intestinal sutures, 18 cases of persistent peritonitis. 39 patients died. 123 patients were diagnosed with comorbidities.

Clinical and laboratory data, parameters of the MPI, comorbidity class (CC) [7], the patients’ age were analyzed using the variance analysis.

Results and Discussion

We have developed a scale according to which the prediction of POC is carried out in two stages. In the first phase, prior to surgery, the scale included the following parameters: the nature of the underlying disease and peritonitis, parameters of the comorbidity class (Table 1).

Table 1

Scale for predicting postoperative complications in acute peritonitis

Criteria Points
Acute appendicitis, simple acute cholecystitis, gynecological pathology, intestinal obstruction (non-cancerous) without necrosis 1
Intestinal obstruction (non-cancerous) with necrosis, acute destructive cholecystitis, perforation of gastroduodenal ulcers, small intestine, gastric cancer, acute bleeding from peptic ulcer, obstetrical pathology 2
Abdominal trauma, malignant bowel obstruction, Crohn’s disease, acute pancreatitis, mesenteric thrombosis, postoperative peritonitis 3
Localized peritonitis 2
Diffuse peritonitis 4
General peritonitis 6
No class 0
Comorbidity class 0 0
Comorbidity class 1 1
Comorbidity class 2 2
Comorbidity class 3 3

The results of variance analysis confirmed the statistically significant dependence of POC from the indicators being selected for the prediction (Table 2).

Table 2

Scale for predicting preoperative complications

Criteria Points
Characteristics of surgical pathology Table 1
Characteristics of peritonitis MPI
Characteristics of concominant disease Table 1
Number of stab neutrophils (%):
  • less than 3 or more than 37

3
  • 26 - 36

2
  • 4 - 25

0
Use of programmed sanation 2

According to the sum of points determined according to the scale, patients were previously divided into several groups: normal (2-4 points), increased (5-7 points), medium (8-9 points) and high (more than 10 points) risk of POC. It allows us to use the necessary preventive measures at the stage of the preoperative preparation.

The final risk estimation was made considering the data of the intraoperative revision and laboratory tests. The analysis of clinical and laboratory parameters showed that the dispersion of POC parameters was statistically explained by the indicators presented in Table 2. Risk groups differentiation was conducted as follows: less than 18 points – normal risk, 18-25 points - increased risk (primarily wound complications), 26-34 points - average risk (abscesses, infiltrates, diffuse peritonitis, suture failure), more than 35 points - high risk (severe peritonitis, sepsis), that was confirmed by the results of the one-way variance analysis. The assignment of a particular patient to a specific group allows using necessary preventive measures during surgery and in the postoperative period reasonably.

Conclusions

  • The proposed prognostic scale allows us to identify groups of normal, increased, medium and high risk of postoperative complications in acute peritonitis.

  • A two-phase prediction - before and during surgery – allow us to differentially apply preventive measures in the preoperative preparation, during surgery and in the postoperative period of treatment.

Prospects for further research

Further research should be directed at wide clinical approbation of the developed method and its evaluation.

References

1 

RA Pryhidko. Prognozuvannya rozvytku hniino-zapalnykh uskladnen pry hostrii intraabdominalnii patolohii. Aktual probl suchasn med: Visn Ukr med stomat acad. 2015;15(2):127-129. Ukrainian

2 

FV Grynchuk, IYu Polianskiy, VV Preutesei, AF Grynchuk. New scoring system for predicting postsurgical complications in abdominal surgery. Arta medica. 2015;3(56):53-54.

3 

IA Kryvoruchko, YuV Ivanova, MS Povelichenko, SA Andreeschev. Khirurhichne likuvannia khvorykh na abdominalnyi sepsis z vykorystanniam skoryngovykh system otsinky tiazhkosti khvorykh. Arkh klinich med. 2014;2(2):68-71. Ukrainian

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K Ott, U Heger. Are There Gender-Specific Differences in Complications Following Abdominal Surgery. Zentralbl Chir. 2015;140(3):273-278. doi:10.1055/s-0035-1545824

5 

M Torba, A Gjata, S Buci, G Bushi, A Zenelaj, I Kajo, S Koceku, K Kagjini, K Subashi. The influence of the risk factor on the abdominal complications in colon injury management. G Chir. 2015;36(2):57-62. doi:10.11138/gchir/2015.36.2.057

6 

MM Linder, H Wacha, U Feldmann, G Wesch, RA Streifensand, E Gundlach. Der Mannheimer Peritonitis – Index. Chirurg. 1987;58(2):84-92. Cited in: PubMed; PMID 3568820. German

7 

FV Grynchuk, IYu Polianskiy. A new scoring system for comorbidity assessment in urgent abdominal surgery. Arta medica. 2015;3(56):52-53.



Copyright (c) 2017 A F Grynchuk, F V. Grynchuk, I Yu Polianskiy

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