Predictors of postoperative outcome in emergency laparotomy for perforation peritonitis-A prospective cross sectional study

Gastrointestinal tract perforation is one of the most common surgical emergencies worldwide. Peritonitis causing the sepsis and systemic complications due to the perforation are still responsible for significant mortality despite the advent of newer antibiotics, safe operative and anaesthetic techniques, and an improved understanding of pre and postoperative management . Rapid source control through surgical exploration and prudent antimicrobial therapy is fundamental for treating intra-abdominal sepsis due to perforation. Billing et al. proposed early prognostic assessment of patients with perforation peritonitis to allow triaging of patients for a more aggressive therapeutic approach . Several scoring systems have since been developed to enable general and prognostic evaluation of patients with perforation peritonitis . Bohen et al. did an anatomical classification of intra-abdominal infections into three groups (group I- appendicitis and perforated duodenal ulcer; group II- peritonitis from all other intra-abdominal organs, not following surgery; and group III- postoperative peritonitis) and showed a difference in outcomes between them. The Acute Physiology and Chronic Health Evaluation (APACHE) system, on the other hand, is a non-specific physiologic scoring system that has been validated for risk stratification and has also been used in several studies for intra-abdominal infections . Meakins and associates proposed an approach for the study and clinical management of intra- abdominal infections that combined functional and anatomical components. Singh et al. did a prospective analysis of 84 patients with perforation peritonitis and identified laboratory indices, delay in presentation, and surgery as good predictors of postoperative mortality. Most of these scoring systems are exhaustive and challenging to use in emergency departments. This study aimed to evaluate the predictive factors of postoperative outcome in patients undergoing emergency laparotomy for perforation peritonitis.