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Preoperative prognostic factors for severe diffuse secondary peritonitis: a retrospective study

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Abstract

Purpose

The aim of this study was to analyse preoperative risk factors for mortality or intensive care unit admission to describe severe peritonitis.

Methods

This was a single academic centre retrospective study of consecutive adult patients operated for diffuse secondary peritonitis between 2012 and 2013. Patients with appendicitis or cholecystitis were excluded. Independent risk factors were identified using binary and ordinal logistic regression.

Results

A total of 223 patients were analysed. Overall 30-day mortality was 14.5 %. Postoperatively, 32.3 % of patients were admitted into the intensive care unit (ICU). Independent risk factors for severe peritonitis were septic shock (odds ratio (OR) 37.94, 95 % confidence interval (CI) 14.52–99.13), chronic kidney insufficiency (OR 5.98 (95 % CI 1.56–22.86), severe sepsis (OR 4.80, 95 % CI 2.10–10.65) and cardiovascular disease (OR 2.58, 95 % CI 1.22–5.47). Patients lacking these factors had no mortality. ICU admission was refused in 24 (10.8 %) patients with 70.8 % mortality. In a subgroup of patients without treatment limitations (n = 190), independent risk factors for weighted outcome of ICU admission or mortality were septic shock (OR 11.89, 95 % CI 4.98–28.40), severe sepsis (OR 5.56, 95 % CI 2.39–12.89), metastatic malignant disease or lymphoma (OR 3.11, 95 % CI 1.34–7.20) and corticosteroid use (OR 2.98, 95 % CI 1.18–7.51). When receiving full level of care, patients with preoperative organ dysfunctions in this subgroup had 8.2 % 30-day mortality.

Conclusions

Preoperative organ dysfunctions, chronic kidney insufficiency and cardiovascular disease are the most important risk factors for severe peritonitis. Without these risk factors, patients had no mortality.

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Acknowledgments

We would like to thank Juho Mattila and Tomi Eronen for providing us with the data on emergency department and ICU patients, respectively.

Authors’ contributions

MT had full access to the data in the study and takes responsibility for the acquisition and integrity of the data and the accuracy of the data analysis. MT drafted the manuscript with the help of VS and PM. All authors (MT, VS, PM, AL) have been involved in study conception and design, analysis and interpretation of the data and revising the manuscript. All authors have read and approved the final manuscript and agree to be accountable for all aspects of the work.

Author information

Authors and Affiliations

  1. Department of Abdominal Surgery, University of Helsinki and Helsinki University Hospital Meilahti, Haartmaninkatu 4, 00290, Helsinki, Finland

    Matti Tolonen, Ville Sallinen, Panu Mentula & Ari Leppäniemi

  2. Department of Transplantation and Liver Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland

    Ville Sallinen

Authors
  1. Matti Tolonen
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  2. Ville Sallinen
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  3. Panu Mentula
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  4. Ari Leppäniemi
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Corresponding author

Correspondence to Matti Tolonen.

Ethics declarations

This study was financially supported by the Martti I. Turunen Foundation and Helsinki University Central Hospital Research Funds (Government Research Funds). The study was merely observational, and neither informed consent nor ethics committee’s approval was needed. Study design was approved by institutional review board (Helsinki University Central Hospital) on June 13, 2013.

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

This study was presented at National Operative Days Conference, 25 November 2015, Helsinki, Finland

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Tolonen, M., Sallinen, V., Mentula, P. et al. Preoperative prognostic factors for severe diffuse secondary peritonitis: a retrospective study. Langenbecks Arch Surg 401, 611–617 (2016). https://doi.org/10.1007/s00423-016-1454-8

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  • DOI: https://doi.org/10.1007/s00423-016-1454-8

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