Acute generalized peritonitis in adult African patients: Assessment of severity using APACHE II score

Abstract

Background: Generalized surgical acute abdomen is a significant cause of morbidity and mortality in the Nigerian environment. Severity assessment is useful in order to prioritize treatment and reduce morbidity and mortality. High severity scores are often faced with high morbidity and mortality; these patients, often require more intensive treatment than those with low severity scores. The purpose of this study was to assess the severity of generalized surgical acute abdomen in adult patients using the Acute Physiological and Chronic Ill Health Evaluation (APACHE II) score.Methods: All patients (184) aged 16 years and above, admitted and operated for generalized acute abdomen over a period of 6 years from January 1993 to December 1998 were prospectively studied. Demographic, clinical, preoperative, operative and postoperative data on each patient were entered into a prepared proforma. Severity of illness was assessed using APACHE II parameters. Postoperative outcome and severity of illness were compared to determine the significance of severity of illness on postoperative outcome.Results: Thirty‐one patients (17%) died and 78 (42.4%) developed other postoperative complications. The APACHE II scores significantly correlated with the mortality and such other postoperative complications as residual intra‐abdominal abscess, abdominal sepsis, chest infection and faecal fistula (P < 0.05) and the duration of hospital stay (P < 0.05). The APACHE II scores ranged from 0 to 18, the mean score for survivors was 5.7, while it was 12.3 for those who did not survive. Only three (4%) patients who scored 0–5 died, six (9.4%) patients who scored 6–10, 15 (50%) patients who scored 11–15 and seven patients (87.5%) died who scored 16–20.Conclusion: The study showed that the severity of generalized peritonitis can be suitably assessed by APACHE II score in our environment and may serve as means of objective assessment of the quality of care. APACHE II score predicted mortality and morbidity in the patients studied. A further study is needed involving a larger number of patients to further validate our findings. We recommend to surgeons practicing in an environment similar to ours and to use the APACHE II scoring system in the assessment of patients with acute generalized peritonitis.