Pre-operative Apache II score as a tool to predict outcome in patients with gastrointestinal perforation at RIMS, Ranchi.
Journal Title: IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) - Year 2018, Vol 17, Issue 11
Abstract
Background: Perforation peritonitis is one of the most commonly encountered surgical emergencies by a resident surgeon. Many scoring systems have been used to predict the mortality and the outcome of the patients presenting with secondary peritonitis. The study aims at using APACHE II score preoperatively and correlate with post-operative outcomes in patients with gastrointestinal perforation and to observe its accuracy and limitations in predicting post-operative morbidity and mortality. Material and Methods: This was a prospective cross sectional study which was carried out in the department of surgery at Rajendra Institute of Medical Sciences, Ranchi, Jharkhand (India)from November 2015 to October 2017 on 52 patients admitted for gastrointestinal perforation. The objective was to evaluate APACHE II score in predicting outcome of patients having gastrointestinal perforation. Results: The mortality rate in the study was 15.4%, all patients having APACHE II score ≥21 with mean APACHE II score 26.3±3.The most common morbidity faced was surgical site infection and wound failure. The average hospital stay was 11.5±4.9006 days, maximum being 14.33 days in the middle group. The area under the ROC curve for mortality prediction by APACHE II score was 0.966 with 100% sensitivity and 90.91% specificity. Other components contributing to increased mortality include increasing age, GCS<15, preoperative renal failure, tachycardia, hyponatremia, hyperkalaemia and acidic pH. Conclusion: The outcome can range from uneventful discharge to death. Patients with score≥11 were at a risk of developing complications and a rise of score to more than 20 carries a very high risk of mortality. The sensitivity of APACHE II score to predict post-operative mortality ranges between 92.31-100%. Thus it is a good tool for guiding management. However APACHE II score cannot specifically predict the morbidity of the patients. Individual components of APACHE II also give a rough idea and forms risk factors in mortality prediction.
Authors and Affiliations
Gaurav Mishra, Nishith M Paul Ekka, Tanushree Kar, Ashutosh Kumar Tiwari, Vishal Prakash, Vinod Kumar
Keywords
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