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

Area of Science:

• Surgical Gastroenterology
• Critical Care Medicine
• Epidemiology

Background:

• Diffuse secondary peritonitis is a severe surgical emergency.
• Identifying preoperative risk factors is crucial for predicting patient outcomes and guiding treatment intensity.

Purpose of the Study:

• To analyze preoperative risk factors associated with mortality and intensive care unit (ICU) admission in patients with severe peritonitis.
• To describe the clinical characteristics of severe peritonitis.

Main Methods:

• Retrospective analysis of consecutive adult patients undergoing surgery for diffuse secondary peritonitis (2012-2013).
• Exclusion of patients with appendicitis or cholecystitis.
• Identification of independent risk factors using binary and ordinal logistic regression.

Main Results:

• Overall 30-day mortality was 14.5%, with 32.3% requiring ICU admission.
• Independent risk factors for severe peritonitis included septic shock (OR 37.94), chronic kidney insufficiency (OR 5.98), severe sepsis (OR 4.80), and cardiovascular disease (OR 2.58).
• Patients without these risk factors exhibited no mortality. In a subgroup without treatment limitations, risk factors for ICU admission or mortality included septic shock, severe sepsis, metastatic malignant disease, and corticosteroid use.

Conclusions:

• Preoperative organ dysfunction, chronic kidney insufficiency, and cardiovascular disease are significant risk factors for severe peritonitis.
• Absence of these risk factors correlated with zero mortality, emphasizing their prognostic importance.
• Early identification and management of these risk factors are essential for improving survival in peritonitis patients.