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Prognostic factors in patients with gastrointestinal perforation under the acute care surgery model : a retrospective
Kiyoung Sung1, Sanguk Hwang2, Jaeheon Lee1
1Department of Surgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Insights
Postoperative outcomes in gastrointestinal perforation (GIP) patients are predicted by Sequential Organ Failure Assessment (SOFA) scores, albumin levels, and body temperature. These factors are crucial for identifying high-risk patients and improving critical care strategies.
Area of Science:
- Surgery
- Critical Care Medicine
- Gastroenterology
Background:
- Gastrointestinal perforation (GIP) is a critical surgical emergency requiring immediate intervention.
- Standardized acute care surgery (ACS) frameworks are essential for managing GIP patients.
- Identifying prognostic factors is vital for optimizing GIP patient outcomes.
Purpose of the Study:
- To identify independent prognostic factors for mortality and morbidity in GIP patients treated within an ACS framework.
- To evaluate the predictive accuracy of identified factors using statistical models.
- To inform evidence-based postoperative critical care strategies for GIP.
Main Methods:
- Single-center retrospective cohort study of 354 GIP patients undergoing emergent surgery and ICU admission (January 2013 - March 2023).
- Analysis of initial and postoperative Sequential Organ Failure Assessment (SOFA) scores, postoperative body temperature, peritonitis extent, surgical approach, and postoperative albumin levels.
- Utilized Random Forest models to determine feature importance for predicting survival and complications.
Main Results:
- Overall mortality was 11%; 38% of survivors experienced severe complications (Clavien-Dindo class III+).
- Independent predictors of mortality included initial SOFA, postoperative SOFA (p-SOFA), and postoperative body temperature.
- Independent predictors of morbidity included peritonitis extent, open surgery, postoperative albumin, and p-SOFA scores.
- Random Forest analysis highlighted p-SOFA and postoperative albumin as key predictors for both survival and complications.
- Specific combinations of high p-SOFA, low albumin, and low body temperature indicated 100% mortality.
Conclusions:
- Rapid preoperative assessment, accurate surgery, and evidence-based postoperative care are crucial for GIP management.
- Postoperative SOFA scores, albumin levels, and body temperature are critical indicators for predicting patient outcomes.
- Implementing a system to assess these factors can lead to more detailed patient evaluations and improved care.
Background:
Gastrointestinal perforation (GIP) is a life-threatening condition that necessitates immediate surgical intervention. This study aims to identify prognostic factors in patients with GIP treated within a standardized acute care surgery (ACS) framework.
Materials And Methods:
This single center retrospective cohort study analyzed patients diagnosed with GIP who underwent emergent surgery and were admitted to the intensive care unit between January 2013 and March 2023.
Results:
Among 354 patients, the mortality was 11%, and 38% of survivors experienced significant complications (Clavien-Dindo class III or higher). Independent prognostic factors for mortality included initial sequential organ failure assessment (SOFA) scores (at the time of admission or ACS activation), postoperative SOFA (p-SOFA) scores, and postoperative body temperatures. For morbidity, independent predictors were the extent of peritonitis, the open surgery, postoperative albumin levels, and p-SOFA scores. These factors showed significant predictive accuracy for patient outcomes, as evidenced by the area under the receiver operating characteristic curve. The Random Forest model identified p-SOFA scores and postoperative albumin levels as the most significant predictors for both survival and complications, with feature importances of 40.46% and 36.61% for survival, and 39.97% and 37.28% for complications, respectively. Postoperative body temperature also played a moderately important role, contributing 14.63% to mortality and 15.9% to morbidity predictions. Patients with a p-SOFA score ≥ 7, postoperative albumin ≤ 2, and body temperature ≤ 36 °C, as well as those with a p-SOFA score ≥ 10, albumin ≤ 2.9, and body temperature ≤ 36 °C, had a 100% mortality rate. These factors are critical indicators for predicting patient outcomes.
Conclusion:
It is crucial to establish a system that ensures rapid preoperative work-up, accurate surgical intervention, and evidence-based postoperative critical care. Implementing such a system and assessing patient outcomes after surgery using the identified factors could provide a more detailed evaluation.
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