Evaluation of risk factors associated with hyperbilirubinemia after surgery of perforation peritonitis

Abstract

Aim: Gastrointestinal (GI) perforation repair is a commonly performed surgery worldwide. Postoperative septic conditions are frequently accompanied by cholestasis and postoperative jaundice. Our study was conducted to evaluate the risk factors and outcome of postoperative hyperbilirubinemia in patients with perforation peritonitis. Materials and Methods: A prospective observational study of 100 patients was conducted between January 2013 and December 2014; they underwent surgery for generalized peritonitis caused by GI perforations in the Department of Surgery of JLN Medical College and Associated Group of Hospitals, Ajmer, Rajasthan, India. Postoperative hyperbilirubinemia is defined as serum total bilirubin level of ≥5 mg/dl within 1 month after surgery. In all the patients with postoperative hyperbilirubinemia, risk factors and outcome were assessed. Data analyses done with Fisher's exact test, Mann–Whitney test, Chi-square test, Student's t test, and repeated-measures analysis of variance were used for statistical comparisons. Results: In our study of 100 patients, M:F ratio was 2.12. Sixteen percent of the total patients belonged to hyperbilirubinemia group and 84% belonged to no hyperbilirubinemia group. In the hyperbilirubinemia group, anemia was seen in 37.5%, poor nutrition in 44%, and shock in 62.5%, and these patients also had increased total leukocyte count counts, bilirubin level, aspartate aminotransferase level, and decreased platelet count, whereas in the no hyperbilirubinemia patients anemia was seen in 11%, poor nutrition in 15%, and shock in 15% cases and all of them had normal blood investigations. Postoperatively, in the hyperbilirubinemia group, cardiac and respiratory support was needed in 62% and 72% cases, respectively, renal insufficiency in 56% cases, prolonged paralytic ileus in 72%, and mortality in 62% cases. Infection-related complications developed in 20 patients (12 patients of hyperbilirubinemia group and 8 patients of no hyperbilirubinemia group). Conclusion: In our study, we concluded that in cases of perforation peritonitis, hyperbilirubinemia was associated with advanced age, poor nutritional status, and prolonged time until surgical intervention, and these patients with postoperative hyperbilirubinemia showed higher morbidity and mortality after surgery.