Factors associated with mortality in patients with peritonitis presenting for anesthesia and surgery in a tertiary center in Nigeria - A cross-sectional study

Abstract

Background: Peritonitis is one of the surgical emergencies commonly encountered by the general surgeons. Sepsis, dehydration, hypovolemia, and multiple organ dysfunctions have been associated with high mortality rate. The study aimed to assess risk factors associated with mortality in patients with peritonitis presenting for anesthesia and surgery in a tertiary institution. Methods: We conducted a prospective cross-sectional study involving consenting patients managed for peritonitis under general anesthesia over a year period. A study proforma was used to collect the data on demographic characteristics and clinical and biochemical parameters. The association between postoperative mortality and demographic characteristics and clinical and biochemical parameters was determined with Chi-square test, and the level of significance was set at P < 0.05. Results: A total of 52 adult patients were studied with 38 (73.1%) males and 14 (26.9%) females. The mean age was 39.7 ± 15.3 years. Nineteen patients died, and the mortality rate was 36.5%. Mortality was more in females and in patients more than 50 years (P = 0.917 and P = 0.34), respectively. Preoperative high American Society of Anesthesiologists (ASAs) physical status (P = 0.002), higher Mannheim Peritonitis Index (MPI) scores (P = 0.005), preoperative systolic blood pressure <100 mmHg (P = 0.006) and preoperative respiratory rate more than 30 breaths/min (P = 0.002), serum creatinine level more than 1.5 (P = 0.04), and acidosis (P = 0.02) were statistically significant risk factors for mortality in this study. Conclusion: The mortality following perforation peritonitis is high in our center. Poor outcome is seen in patients with high ASA status, high MPI scores, preoperative shock, acidosis, renal failure, and tachypnea. Proper resuscitation from shock, correction of acidosis, and improving the ASA status will improve survival in patients with perforated peritonitis.