Role of intra-abdominal pressure in the outcomes of perforation peritonitis: A prospective observational study
Pritesh Kumar N, Lovenish Bains, Pawan Lal, Anurag Mishra, Mohd Yasir Beg, Haraesh Maranna
Department of Surgery, Maulana Azad Medical College, New Delhi, India
Objective: Intra-abdominal pressure (IAP) has been investigated for its role in causing morbidity and mortality, with various studies showing different degrees of correlation. There remains paucity of literature on this subject, applied to patients of perforation peritonitis, especially in the Indian subcontinent.
Material and Methods: It is a prospective observational study involving 40 patients of perforation peritonitis undergoing exploratory laparotomy. IAP was measured as per WSACS (World Society of Abdominal Compartment Syndrome) guidelines. APACHE II (Acute Physiology And Chronic Health Evaluation- II) and SOFA (Sequential Organ Failure Assessment) were calculated. Data was collected regarding occurrence of prolonged ileus, burst abdomen, duration of hospital stay, 30 day mortality, and was statistically analyzed to correlate with IAP.
Results: At admission, mean IAP was 13.37 mmHg, and the incidence of IAH was 65%. IAH was seen in 17.9% and 7.6% at 24 h and 48 h post-operatively. Incidence of prolonged ileus and burst abdomen were 7.7% and 22.5% respectively. Mortality rate was 17.5%. Mean duration of hospital stay was 13.45 days. Post-operative IAP correlated with mortality (p: 0.014) and post-operative SOFA score (p< 0.05). Statistically significant correlation was also seen with the occurrence of prolonged ileus (p: 0.006). IAP did not significantly correlate with APACHE II score, occurrence of burst abdomen, and duration of hospital stay.
Conclusion: Rise in IAP correlates with deterioration of SOFA score, and also with the occurrence of prolonged ileus. IAP is also a predictor of mortality. IAP measured post-operatively (24 and 48 hours) had a better correlation with these outcomes than the value measured at admission. No statistically significant correlation of IAP with the occurrence of burst abdomen and duration of hospital stay could be found, which warrants further studies with a larger population.
Keywords: Perforation peritonitis, intra-abdominal pressure, intra-abdominal hypertension, abdominal compartment syndrome
Cite this article as: Kumar NP, Bains L, Lal P, Mishra A, Beg MY, Maranna H. Role of intra-abdominal pressure in the outcomes of perforation peritonitis: A prospective observational study. Turk J Surg 2021; 37 (3): 253-259.
This was obtained from Maulana Azad Medical College and Associated Hospital Instutional Ethics Commitee. (Date: 21.10.2018, Decision no: 17/IEC/MAMC/2018/15)
Concept –L.B., P.L., P.K.N.; Design – L.B., P.K.N., A.M.; Supervision –P.L., A.M., P.K.N., L.B.; Data Collection and/or Processing - L.B., P.K.N., M.Y.B.; Analysis and/or Interpretation – L.B. P.K.N., P.L., A.M.; Literature Search – L.B. P.K.N., P.L., A.M.; Writing Manuscript – P.K.N., L.B., H.M., Critical Reviews – All of authors.
The authors have no conflicts of interest to declare.
The authors declared that this study has received no financial support.