During the study, 354 patients were analyzed, with an 11% mortality rate (42 patients) and 38% of survivors (129 out of 312) experiencing Clavien-Dindo Class III or higher complications. Table 1 highlights differences between nonsurvivors and survivors: nonsurvivors were older (75 vs. 64 years, P = 0.00), required hihger level of intensive care, had higher American society of anesthesiologists (ASA) scores (P = 0.00), and a greater prevalence of severe organ insufficiency (78.57% vs. 35.09%, P = 0.00). Invasive operations were more common among nonsurvivors, with a higher rate of open surgery (92.86% vs. 78.53%, P = 0.05) and damage-control surgeries (7.14% vs. 0%, P = 0.00). No significant differences were observed in operation time or urine output, but nonsurvivors received more crystalloid infusion (2,105ml vs. 1,571ml, P = 0.01). The time from Sx onset to ACS activation was longer for nonsurvivors (2.33 days vs. 1.22 days, P = 0.04), with no significant differences in the time from admission to surgery, Sx onset to visit, and admission routes. Colorectal perforation found during the operation was more prevalent in nonsurvivors (52.38% vs. 32.37%, P = 0.02), with mesenteric ischemia being a common cause (26.19%, P = 0.03). The peritoneal contamination due to colorectal origin was significantly higher in nonsurvivors (54.76% vs. 30.77%, P = 0.00), although no differences were observed in the source and extent of intraperitoneal contamination, preoperative computed tomography (CT) findings, intraoperative findings, or final pathology between the groups. After surgery, nonsurvivors had longer ICU stays (7.57 days vs. 4.68 days, P = 0.00), though survivors had longer hospital stays (14.76 days vs. 18.45 days, P = 0.00), not considered clinically significant. Preoperative laboratory data showed nonsurvivors with higher blood urea nitrogen (BUN) (35.73 mg/dL vs. 25.28 mg/dL, P = 0.00) and creatinine levels (2.16 mg/dL vs. 1.38 mg/dL, P = 0.00), total bilirubin ( 0.99 mg/dL vs. 0.82 mg/dL, P = 0.01) but lower aspartate transaminase (AST) (34.4 U/L vs. 37.01 U/L, P = 0.00) and albumin (3.41 g/dL vs. 3.77 g/dL, P = 0.00). They exhibited higher i-SOFA scores (4.59 vs. 1.78, P = 0.00), lower ratio of arterial oxygen partial pressure to fractional inspired oxygen (PF) (291.85 vs. 342.66, P = 0.01), and lower SBP (123.07 mmHg vs. 136.44 mmHg, P = 0.00), with a higher incidence of circulatory shock (52.38% vs. 21.15%, P = 0.00). Postoperatively, worsened clinical indicators in nonsurvivors included elevated acute physiology and chronic health evaluation (APACHE) II score (21.09 vs. 10.43, P = 0.00) and SOFA score (7.14 vs. 2.89, P = 0.00), and lower PF ratio (290.38 vs. 354.19, P = 0.02). Temperature measurements were consistently lower in nonsurvivors. Following surgery, lab results revealed that nonsurvivors had significantly lower white blood cell (WBC) counts (9,134 /mL vs. 11,429 /mL, P = 0.00), hemoglobin (11.10 g/dL vs. 12.21 g/dL, P = 0.00), hematocrit (33.12% vs. 36.01%, P = 0.00), and platelet counts (156.9 x 109/L vs. 235.21 x 109/L, P = 0.00), along with decreased albumin (2.51 g/dL vs. 3 g/dL, P = 0.00) and AST levels (41.45 U/L vs. 44.61 U/L, P = 0.02). In contrast, creatinine (1.87 mg/dL vs. 1.21 mg/dL, P = 0.00), BUN (32.97 mg/dL vs. 22.11 mg/dL, P = 0.00) were higher in nonsurvivors, indicating renal stress and liver dysfunction. Nonsurvivors also required more red blood cell (RBC) transfusions during surgery (1.16 units vs. 0.04 units, P = 0.00) and in the postoperative period (1.92 units vs. 0.93 units, P = 0.00), with an increased need for mechanical ventilation, renal replacement, and a higher incidence of delirium, highlighting a more critical clinical condition.
Table 1
Comparison of differences among the entire patient group, deceased group, and survivor group.
| Total (n = 354) | Survivor (n = 312) | Nonsurvivor (n = 42) | P* |
Gender | | | | 0.41 |
male | 202 (57.06) | 181 (58.01) | 21 (50.00) | |
female | 152 (42.94) | 131 (41.99) | 21 (50.00) | |
Age (years) | 65.89 ± 15.40 | 64.64 ± 15.47 | 75.14 ± 11.13 | 0.00 |
Level of intensive care | | | | 0.00 |
1 | 128 (36.16) | 126 (40.38) | 2 (4.76) | |
2 | 142 (40.11) | 133 (42.63) | 9 (21.43) | |
3 | 84 (23.73) | 53 (16.99) | 31 (73.81) | |
ASA physical status | | | | 0.00 |
1 | 46 (12.99) | 46 (14.74) | 0 (0.00) | |
2 | 118 (33.33) | 112 (35.90) | 6 (14.29) | |
3 | 149 (42.09) | 127 (40.71) | 22 (52.38) | |
4 | 36 (10.17) | 24 (7.69) | 12 (28.57) | |
5 | 5 (1.41) | 3 (0.96) | 2 (4.76) | |
Type of surgery | | | | 0.05 |
open | 284 (80.23) | 245 (78.53) | 39 (92.86) | |
laparoscopy | 70 (19.77) | 67 (21.47) | 3 (7.14) | |
Type of surgery | | | | 0.00 |
primary repair or wedge resection | 114 (32.20) | 106 (33.97) | 8 (19.05) | |
resection and anastomosis | 130 (36.72) | 115 (36.86) | 15 (35.71) | |
resection and diversion | 78 (22.03) | 63 (20.19) | 15 (35.71) | |
exploration, definite | 20 (5.65) | 19 (6.09) | 1 (2.38) | |
exploration, damage-control | 3 (0.85) | 0 (0.00) | 3 (7.14) | |
appendectomy | 9 (2.54) | 9 (2.88) | 0 (0.00) | |
Operation time (mins) | 143.72 ± 60.04 | 143.18 ± 59.09 | 147.76 ± 66.50 | 0.88 |
Intra-op fluid (ml) | | | | |
crystalloid | 1634.59 ± 1105.71 | 1571.20 ± 1055.86 | 2105.47 ± 1330.97 | 0.01 |
colloid | 242.43 ± 303.58 | 234.85 ± 294.11 | 307.14 ± 360.05 | 0.12 |
Intra-op urine output (ml) | 220.04 ± 232.05 | 216.19 ± 212.65 | 248.57 ± 341.75 | 0.53 |
Door to op (mins) | 265.90 ± 148.56 | 264.30 ± 147.89 | 278.17 ± 156.83 | 0.59 |
Symptom onset to visit (days) | 1.16 ± 2.95 | 1.05 ± 2.55 | 1.97 ± 4.97 | 0.15 |
Symptom onset to ACS activation (days) | 1.35 ± 3.14 | 1.22 ± 2.74 | 2.33 ± 5.21 | 0.04 |
Process to operation | | | | 0.07 |
visit to ER | 293 (82.77) | 262 (83.97) | 31 (73.81) | |
inpatient (other departments ) | 43 (12.15) | 37 (11.86) | 6 (14.29) | |
inpatient (GS) | 18 (5.08) | 13 (4.17) | 5 (11.90) | |
Routes of admission | | | | 0.12 |
direct | 318 (89.83) | 281 (90.06) | 37 (88.10) | |
transfer from other hospital | 27 (7.63) | 25 (8.01) | 2 (4.76) | |
inpatient | 9 (2.54) | 6 (1.92) | 3 (7.14) | |
History of severe organ insufficiency | 145 (40.96) | 112 (35.09) | 33 (78.57) | 0.00 |
Perforated organ on preoperative CT | | | | 0.38 |
Stomach | 30 (8.47) | 26 (8.33) | 4 (9.52) | |
Duodenum | 48 (13.56) | 46 (14.74) | 2 (4.76) | |
Small intestine | 97 (27.40) | 83 (26.60) | 14 (33.33) | |
Colorectum | 91 (25.71) | 80 (25.64) | 11 (26.19) | |
cannot specify, but can confirm the perforation | 37 (10.45) | 33 (10.58) | 4 (9.52) | |
no evidence of perforation | 26 (7.34) | 21 (6.73) | 5 (11.90) | |
cannot perform CT scan | 10 (2.82) | 9 (2.88) | 1 (2.38) | |
12 (3.39) | 12 (3.85) | 0 (0.00) | |
esophagus | 3 (0.85) | 2 (0.64) | 1 (2.38) | |
Colorectal perforation on preoperative CT | 91 (25.71) | 80 (25.64) | 11 (26.19) | 1.00 |
Perforated organ on operative findings | | | | 0.14 |
stomach | 33 (9.32) | 28 (8.97) | 5 (11.90) | |
duodenum | 60 (16.95) | 58 (18.59) | 2 (4.76) | |
small intestine | 116 (32.77) | 104 (33.33) | 12 (28.57) | |
colorectum | 123 (34.75) | 101 (32.37) | 22 (52.38) | |
can not be found | 4 (1.13) | 4 (1.28) | 0 (0.00) | |
14 (3.95) | 13 (4.17) | 1 (2.38) | |
esophagus | 1 (0.28) | 1 (0.32) | 0 (0.00) | |
not perforation | 3 (0.85) | 3 (0.96) | 0 (0.00) | |
Colorectal perforation on operative findings | 123 (34.57) | 101 (32.37) | 22 (52.38) | 0.02 |
Cause of the perforation on operative findings | | | | 0.03 |
neoplasm, malignancy | 44 (12.43) | 38 (12.18) | 6 (14.29) | |
neoplasm, benign | 2 (0.56) | 2 (0.64) | 0 (0.00) | |
trauma | 32 (9.04) | 31 (9.94) | 1 (2.38) | |
intestinal obstruction | 60 (16.95) | 53 (16.99) | 7 (16.67) | |
mesenteric ischemia | 30 (8.47) | 19 (6.09) | 11 (26.19) | |
iatrogenic | 27 (7.63) | 24 (7.69) | 3 (7.14) | |
foreign body-related | 1 (0.28) | 1 (0.32) | 0 (0.00) | |
inflammatory bowel disease | 6 (1.69) | 6 (1.92) | 0 (0.00) | |
appendicitis | 15 (4.24) | 14 (4.49) | 1 (2.38) | |
peptic ulcer | 78 (22.03) | 73 (23.40) | 5 (11.90) | |
diverticular, colo-rectal | 18 (5.08) | 17 (5.45) | 1 (2.38) | |
diverticular, non-colonic | 3 (0.85) | 3 (0.96) | 0 (0.00) | |
tuberculosis | 4 (1.13) | 3 (0.96) | 1 (2.38) | |
can not be specified | 34 (9.60) | 28 (8.97) | 6 (14.29) | |
Final pathology | | | | 0.54 |
neoplasm, malignancy | 43 (12.15) | 35 (11.22) | 8 (19.05) | |
neoplasm, benign | 6 (1.69) | 6 (1.92) | 0 (0.00) | |
inflammation | 119 (33.62) | 103 (33.01) | 16 (38.10) | |
ischemia | 19 (5.37) | 15 (4.81) | 4 (9.52) | |
inflammatory bowel disease | 4 (1.13) | 4 (1.28) | 0 (0.00) | |
appendicitis | 14 (3.95) | 14 (4.49) | 0 (0.00) | |
peptic ulcer | 22 (6.21) | 19 (6.09) | 3 (7.14) | |
diverticular | 17 (4.80) | 15 (4.81) | 2 (4.76) | |
tuberculosis | 1 (0.28) | 1 (0.32) | 0 (0.00) | |
do not perform | 109 (30.79) | 100 (32.05) | 9 (21.43) | |
Source of the intra-peritoneal contamination | | | | 0.12 |
stomach, duodenum, esophagus | 94 (26.55) | 87 (27.88) | 7 (16.67) | |
small intestine | 104 (29.38) | 94 (30.13) | 10 (23.81) | |
colorectum | 119 (33.62) | 96 (30.77) | 23 (54.76) | |
hepatobiliary | 1 (0.28) | 1 (0.32) | 0 (0.00) | |
appendicitis | 16 (4.52) | 15 (4.81) | 1 (2.38) | |
none | 19 (5.37) | 18 (5.77) | 1 (2.38) | |
retroperitoneum | 1 (0.28) | 1 (0.32) | 0 (0.00) | |
Intra-peritoneal contamination by colorectal origin | 119 (33.62) | 96 (30.77) | 23 (54.76) | 0.00 |
Extent of the intra-peritoneal contamination | | | | 0.46 |
generalized | 202 (57.06) | 176 (56.41) | 26 (61.90) | |
localized | 116 (32.77) | 102 (32.69) | 14 (33.33) | |
none | 36 (10.17) | 34 (10.90) | 2 (4.76) | |
Length of ICU stay (days) | 5.02 ± 5.17 | 4.68 ± 4.79 | 7.57 ± 6.97 | 0.00 |
Post-operative length of hospital stay (days) | 18.01 ± 13.08 | 18.45 ± 12.57 | 14.76 ± 16.22 | 0.00 |
Clinical parameters, estimated at first | | | | |
circulatory shock | 88 (24.86) | 66 (21.15) | 22 (52.38) | 0.00 |
PF ratio | 333.39 ± 93.90 | 342.66 ± 87.24 | 291.85 ± 111.95 | 0.01 |
SOFA score | 2.12 ± 2.61 | 1.78 ± 2.27 | 4.59 ± 3.49 | 0.00 |
systolic Blood pressure (mmHg) | 134.85 ± 27.19 | 136.44 ± 26.44 | 123.07 ± 30.02 | 0.00 |
Laboratory results, estimated at first | | | | |
white blood cell count (/mL) | 11246.39 ± 5960.99 | 11060 ± 5423.44 | 12660.24 ± 9029.40 | 0.80 |
hemoglobin (g/dL) | 12.80 ± 2.92 | 12.79 ± 2.67 | 12.90 ± 4.35 | 0.30 |
hematocrit (%) | 37.55 ± 6.90 | 37.76 ± 6.96 | 35.99 ± 6.29 | 0.07 |
platelet (109/L) | 522.59 ± 4830.81 | 267.82 ± 121.72 | 240.90 ± 140.37 | 0.76 |
blood urea nitrogen (mg/dL) | 26.49 ± 38.44 | 25.28 ± 39.80 | 35.73 ± 24.16 | 0.00 |
creatinine (mg/dL) | 1.47 ± 1.78 | 1.38 ± 1.74 | 2.16 ± 1.89 | 0.00 |
AST (U/L) | 36.70 ± 81.99 | 37.01 ± 86.93 | 34.40 ± 21.97 | 0.00 |
ALT (U/L) | 27.64 ± 55.73 | 28.10 ± 58.62 | 24.20 ± 25.15 | 0.59 |
Total bilirubin (mg/dL) | 0.84 ± 0.89 | 0.82 ± 0.91 | 0.99 ± 0.75 | 0.01 |
albumin (g/dL) | 3.73 ± 0.71 | 3.77 ± 0.70 | 3.41 ± 0.71 | 0.00 |
Clinical parameters, immediate postoperative | | | | |
APACH II score | 11.70 ± 7.56 | 10.43 ± 6.45 | 21.09 ± 8.59 | 0.00 |
PF ratio | 345.39 ± 133.93 | 354.19 ± 132.24 | 290.38 ± 133.13 | 0.02 |
SOFA score | 3.39 ± 3.22 | 2.89 ± 2.73 | 7.14 ± 4.00 | 0.00 |
Laboratory results, immediate postoperative | | | | |
white blood cell count (/mL) | 11159.61 ± 7403.75 | 11429.67 ± 7139.14 | 9134.25 ± 8997.52 | 0.00 |
hemoglobin (g/dL) | 12.08 ± 2.06 | 12.21 ± 2.05 | 11.10 ± 1.86 | 0.00 |
hematocrit (%) | 35.67 ± 5.77 | 36.01 ± 5.77 | 33.12 ± 5.16 | 0.00 |
platelet (109/L) | 392.13 ± 302.69 | 235.21 ± 117.71 | 156.90 ± 88.274 | 0.00 |
blood urea nitrogen (mg/dL) | 23.39 ± 16.32 | 22.11 ± 15.12 | 32.97 ± 21.28 | 0.00 |
creatinine (mg/dL) | 1.29 ± 1.58 | 1.21 ± 1.53 | 1.87 ± 1.81 | 0.00 |
AST (U/L) | 44.24 ± 124.70 | 44.61 ± 132.31 | 41.45 ± 31.64 | 0.02 |
ALT (U/L) | 27.49 ± 52.86 | 28.01 ± 55.71 | 23.65 ± 22.26 | 0.79 |
Total bilirubin (mg/dL) | 0.94 ± 0.73 | 0.92 ± 0.70 | 1.07 ± 0.91 | 0.64 |
albumin (g/dL) | 2.94 ± 0.72 | 3 ± 0.70 | 2.51 ± 0.73 | 0.00 |
Body temperature (°C) | | | | |
at the time of admission or ACS activation | 36.89 ± 0.75 | 36.93 ± 0.74 | 36.67 ± 0.76 | 0.05 |
post-op, immediate | 36.37 ± 0.55 | 36.40 ± 0.57 | 36.12 ± 0.36 | 0.00 |
peak body temperature (operation day) | 37.15 ± 0.75 | 37.2 ± 0.72 | 36.85 ± 0.87 | 0.00 |
peak body temperature (first postoperative day) | 37.50 ± 0.58 | 37.53 ± 0.53 | 37.26 ± 0.86 | 0.01 |
RBC transfusion | | | | |
patients who received RBC before surgery | 77 (21.75) | 60 (19.23) | 17 (40.48) | 0.70 |
amount during the operation (units) | 0.49 ± 1.24 | 0.40 ± 1.04 | 1.16 ± 2.16 | 0.00 |
amount within 24 hrs after surgery (units) | 0.25 ± 0.84 | 0.23 ± 0.73 | 0.40 ± 1.43 | 0.26 |
total amount after surgery (units) | 1.05 ± 2.01 | 0.93 ± 1.85 | 1.92 ± 2.81 | 0.00 |
Patients received mechanical ventilation after surgery | 73 (20.62) | 44 (14.10) | 29 (69.05) | 0.00 |
Patients received continuous renal replacement therapy after surgery | 37 (10.45) | 19 (6.09) | 18 (42.86) | 0.00 |
Patients who developed delirium after surgery | 125 (35.31) | 99 (31.73) | 26 (61.90) | 0.00 |
Values are presented as number (%), or mean ± standard deviation (range). |
*Survivor vs. Nonsurvivor |
ASA = American society of anesthesiologists; op = operation; ACS = acute care surgery; ER = emergency room; GS = general surgery; CT = computed tomography; ICU = intensive care unit; PF = ratio of arterial oxygen partial pressure to fractional inspired oxygen; SOFA = sequential organ failure assessment; AST = aspartate transaminase; ALT = alanine transaminase; APACH = acute physiology and chronic health evaluation; RBC = red blood cell |
Table 2 compares the non-com and com patients. Patients in the com group were older, averaging 69 years, compared to 61 years in the non-com group (P = 0.00). The proportion of patients requiring level 3 intensive care was higher in the com group (40.83%) than in the non-com group (2.08%, P = 0.00). A greater percentage of the com group had ASA scores of 3 or above (71.66% vs. 35.42%, P = 0.00), and a higher incidence of open surgery was noted (94.17% vs. 68.75%, P = 0.00). Primary repair was less frequent in the com group (20.83%) compared to the non-com group (42.19%, P = 0.00), whereas resection and diversion were more common (31.67% vs. 13.02%, P = 0.00). Operation times were longer for the com group, averaging 154 minutes versus 136 minutes for the non-com group (P = 0.00), and intraoperative crystalloid and colloid infusions were higher (2,015 ml vs. 1,293 ml, P = 0.00; 301 ml vs. 193 ml, P = 0.00, respectively). No significant differences were found in intraoperative urine output or the time from door to operation. However, the interval from Sx onset to hospital visit and ACS activation was longer in the com group (1.47 days and 0.79 days, P = 0.00; 1.69 days vs 0.93 days, P = 0 .00, respectively). The percentage of patients transferred from other hospitals was higher in the com group (11.67% vs. 5.73%, P = 0.05), and severe organ insufficiency was more prevalent (54.17% vs. 24.48%, P = 0.00). The rate of colorectal perforation identified during surgery was higher in the com group (36.67% vs. 29.69%, P = 0.03), although univariate analysis of colorectal perforation alone showed no significant difference. Final pathology revealed non-performance in 41.67% of the non-com group, while inflammation was the most common finding in the com group (43.33%, P = 0.00). Generalized peritonitis was more prevalent in the com group (67.05% vs. 49.48%, P = 0.00). The length of ICU stay (7.65 days vs. 2.82 days, P = 0.00) and the total postoperative hospital stay (27.61 days vs. 12.73 days, p = 0.00) were both significantly longer for the com group. Preoperative physiological and severity indicators showed a PF ratio of 326 in the com group versus 362 in the non-com group (P = 0.03), and an i-SOFA score of 3.09 compared to 0.97 (P = 0.03). SBP was lower in the com group (108 mmHg vs. 124 mmHg, P = 0.00), with a higher incidence of circulatory shock (41.67% vs. 8.33%, P = 0.00). Laboratory values before surgery indicated lower hemoglobin (12.18 g/dL vs. 13.17 g/dL, P = 0.00), hematocrit (36.23% vs. 38.72%, P = 0.00), and albumin levels (3.42 g/dL vs. 3.99 g/dL, P = 0.00) in the com group, alongside higher BUN (33.34 mg/dL vs. 20.23 mg/dL, P = 0.00) and creatinine levels (1.57 mg/dL vs. 1.26 mg/dL, P = 0.00). Postoperatively, the com group exhibited a higher APACHE II score (14.57 vs. 7.85, P = 0.00), a lower PF ratio (322 vs. 384, P = 0.00), and an elevated p-SOFA score (4.8 vs. 1.69, P = 0.00). The initial body temperature (BT) and the highest BT on the first postoperative day showed no significant difference between the groups; however, the com group experienced slightly lower BTs immediately after surgery (36.31°C vs. 36.45°C, P = 0.01) and the highest BTs on the day of surgery were also lower in the com group (37.06°C vs. 37.28°C, P = 0.01) compared to the non-com group. Laboratory analyses postoperatively showed the com group had lower WBC count (9,528/mL vs. 12,679/mL, P = 0.00), hemoglobin (11.64 g/dL vs. 12.59 g/dL, P = 0.00), and hematocrit levels (34.63% vs. 36.92%, P = 0.00). Platelet counts were also decreased (221 x 109/L vs. 244 x 109/L, P = 0.02). Renal function indicators were poorer, with higher BUN (26.81 mg/dL vs. 19.04 mg/dL, P = 0.00) and creatinine levels (1.35 mg/dL vs. 1.12 mg/dL, P = 0.00). Liver function as measured by alanine transaminase (ALT) was slightly higher (29.12 U/L vs. 27.27 U/L, P = 0.01), and albumin levels were lower (2.57 g/dL vs. 3.27 g/dL, P = 0.00). The com group required more RBC transfusion, both preoperatively (9.17% vs. 2.08%, P = 0.01) and during surgery (0.75 units vs. 0.17 units, P = 0.00), as well as within 24 hours after surgery (0.41 units vs. 0.11 units, P = 0.00), culminating in a higher total volume of red blood cells transfused postoperatively (1.89 units vs. 0.33 units, P = 0.00). Postoperative interventions, notably mechanical ventilation (35% vs. 1.04%, P = 0.00), renal replacement (12.5% vs. 2.08%, P = 0.00), and delirium (61.67% vs. 13.02%, P = 0.00), were significantly higher in the com group, indicating a more complex postoperative course.
Table 2
Comparison of differences between the group of survivors who developed complications and those who did not.
| Non-complicated (n = 192) | Complicated (n = 120) | P |
Gender | | m | 0.98 |
male | 112 (58.33) | 69 (57.50) | |
female | 80 (41.67) | 51 (42.50) | |
Age (years) | 61.32 ± 16.38 | 69.95 ± 12.29 | 0.00 |
Level of intensive care | | | 0.00 |
1 | 117 (60.94) | 9 (7.50) | |
2 | 71 (36.98) | 62 (51.67) | |
3 | 4 (2.08) | 49 (40.83) | |
ASA physical status | | | 0.00 |
1 | 38 (19.79) | 8 (6.67) | |
2 | 86 (44.79) | 26 (21.67) | |
3 | 63 (32.81) | 64 (53.33) | |
4 | 5 (2.60) | 19 (15.83) | |
5 | 0 (0.00) | 3 (2.50) | |
Type of surgery | | | 0.00 |
open | 132 (68.75) | 113 (94.17) | |
laparoscopy | 60 (31.25) | 7 (5.83) | |
Type of surgery | | | 0.00 |
primary repair or wedge resection | 81 (42.19) | 25 (20.83) | |
resection and anastomosis | 67 (34.90) | 48 (40.00) | |
resection and diversion | 25 (13.02) | 38 (31.67) | |
exploration, definite | 15 (7.81) | 4 (3.33) | |
exploration, damage-control | 0 (0.00) | 0 (0.00) | |
appendectomy | 4 (2.08) | 5 (4.17) | |
Operation time (mins) | 136.00 ± 60.78 | 154.67 ± 54.85 | 0.00 |
Intra-op fluid (ml) | | | |
crystalloid | 1293.56 ± 905.62 | 2015.41 ± 1132.78 | 0.00 |
colloid | 193.07 ± 266.33 | 301.70 ± 324.98 | 0.00 |
Intra-op urine output (ml) | 204.67 ± 199.75 | 234.53 ± 232.22 | 0.19 |
Door to op (mins) | 264.07 ± 154.22 | 264.67 ± 137.79 | 0.61 |
Symptom onset to visit (days) | 0.79 ± 1.96 | 1.47 ± 3.25 | 0.00 |
Symptom onset to ACS activation (days) | 0.93 ± 2.21 | 1.69 ± 3.38 | 0.00 |
Process to operation | | | |
visit to ER | 165 (85.94) | 97 (80.83) | |
inpatient (other departments) | 23 (11.98) | 14 (11.67) | |
inpatient (GS) | 4 (2.08) | 9 (7.50) | |
Routes of admission | | | 0.05 |
direct | 179 (93.23) | 102 (85.00) | |
transfer from other hospital | 11 (5.73) | 14 (11.67) | |
inpatient | 2 (1.04) | 4 (3.33) | |
History of severe organ insufficiency | 47 (24.48) | 65 (54.17) | 0.00 |
Perforated organ on preoperative CT | | | 0.17 |
Stomach | 14 (7.29) | 12 (10.00) | |
Duodenum | 35 (18.23) | 11 (9.17) | |
Small intestine | 54 (28.13) | 28 (23.33) | |
Colorectum | 45 (23.44) | 36 (30.00) | |
cannot specify, but can confirm the perforation | 19 (9.90) | 14 (11.67) | |
no evidence of perforation | 12 (6.25) | 9 (7.50) | |
cannot perform CT scan | 7 (3.65) | 2 (1.67) | |
5 (2.60) | 7 (5.83) | |
esophagus | 1 (0.52) | 1 (0.83) | |
Colorectal perforation on preoperative CT | 45 (23.44) | 36 (30.00) | 0.21 |
Perforated organ on operative findings | | | 0.03 |
stomach | 18 (9.38) | 10 (8.33) | |
duodenum | 45 (23.44) | 13 (10.83) | |
small intestine | 60 (31.25) | 44 (36.67) | |
colorectum | 57 (29.69) | 44 (36.67) | |
can not be found | 4 (2.08) | 0 (0.00) | |
7 (3.65) | 6 (5.00) | |
esophagus | 0 (0.00) | 1 (0.83) | |
not perforation | 1 (0.52) | 2 (1.67) | |
Colorectal perforation on operative findings | 57 (29.69) | 44 (36.67) | 0.25 |
Cause of the perforation on operative findings | | | 0.00 |
neoplasm, malignancy | 22 (11.46) | 16 (13.33) | |
neoplasm, benign | 2 (1.04) | 0 (0.00) | |
trauma | 20 (10.42) | 11 (9.17) | |
intestinal obstruction | 31 (16.15) | 22 (18.33) | |
mesenteric ischemia | 5 (2.60) | 14 (11.67) | |
iatrogenic | 17 (8.85) | 7 (5.83) | |
foreign body-related | 1 (0.52) | 0 (0.00) | |
inflammatory bowel disease | 6 (3.13) | 0 (0.00) | |
appendicitis | 6 (3.13) | 8 (6.67) | |
peptic ulcer | 55 (28.65) | 18 (15.00) | |
diverticular, colo-rectal | 13 (6.77) | 4 (3.33) | |
diverticular, non-colonic | 2 (1.04) | 1 (0.83) | |
tuberculosis | 0 (0.00) | 3 (2.50) | |
can not be specified | 12 (6.25) | 16 (13.33) | |
Final pathology | | | 0.00 |
neoplasm, malignancy | 19 (9.90) | 16 (13.33) | |
neoplasm, benign | 4 (2.08) | 2 (1.67) | |
inflammation | 51 (26.56) | 52 (43.33) | |
ischemia | 6 (3.13) | 9 (7.50) | |
inflammatory bowel disease | 3 (1.56) | 1 (0.83) | |
appendicitis | 6 (3.13) | 8 (6.67) | |
peptic ulcer | 11 (5.73) | 8 (6.67) | |
diverticular | 12 (6.25) | 3 (2.50) | |
tuberculosis | 0 (0.00) | 1 (0.83) | |
do not perform | 80 (41.67) | 20 (16.67) | |
Source of the intra-peritoneal contamination | | | 0.00 |
stomach, duodenum, esophagus | 63 (32.81) | 24 (20.00) | |
small intestine | 49 (25.52) | 45 (37.50) | |
colorectum | 53 (27.60) | 43 (35.83) | |
hepatobiliary | 1 (0.52) | 0 (0.00) | |
appendicitis | 7 (3.65) | 8 (6.67) | |
none | 18 (9.38) | 0 (0.00) | |
retroperitoneum | 1 (0.52) | 0 (0.00) | |
Intra-peritoneal contamination by colorectal origin | 53 (27.60) | 43 (35.83) | 0.16 |
Extent of the intra-peritoneal contamination | | | 0.00 |
generalized | 95 (49.48) | 81 (67.50) | |
localized | 67 (34.90) | 35 (29.17) | |
none | 30 (15.63) | 4 (3.33) | |
Length of ICU stay (days) | 2.82 ± 1.11 | 7.65 ± 6.59 | 0.00 |
Post-operative length of hospital stay (days) | 12.73 ± 4.91 | 27.61 ± 15.38 | 0.00 |
Clinical parameters, estimated at first | | | |
circulatory shock | 16 (8.33) | 50 (41.67) | 0.00 |
PF ratio | 362.01 ± 74.38 | 326.53 ± 94.20 | 0.03 |
SOFA score | 0.97 ± 1.31 | 3.09 ± 2.83 | 0.00 |
systolic Blood pressure (mmHg) | 124.20 ± 21.33 | 108.36 ± 26.59 | 0.00 |
Laboratory results, estimated at first | | | |
white blood cell count (/mL) | 11151.72 ± 4796.46 | 10914.00 ± 6313.21 | 0.35 |
hemoglobin (g/dL) | 13.17 ± 2.41 | 12.18 ± 2.96 | 0.00 |
hematocrit (%) | 38.72 ± 6.20 | 36.23 ± 7.81 | 0.00 |
platelet (109/L) | 262.48 ± 113.04 | 276.33 ± 134.45 | 0.52 |
blood urea nitrogen (mg/dL) | 20.25 ± 14.03 | 33.34 ± 61.00 | 0.00 |
creatinine (mg/dL) | 1.26 ± 2.00 | 1.57 ± 1.20 | 0.00 |
AST (U/L) | 30.81 ± 49.84 | 47.28 ± 126.01 | 0.85 |
ALT (U/L) | 27.54 ± 53.64 | 29.03 ± 66.29 | 0.15 |
Total bilirubin (mg/dL) | 0.81 ± 0.95 | 0.83 ± 0.83 | 0.55 |
albumin (g/dL) | 3.99 ± 0.61 | 3.42 ± 0.69 | 0.00 |
Clinical parameters, immediate postoperative | | | |
APACH II score | 7.85 ± 4.19 | 14.57 ± 7.24 | 0.00 |
PF ratio | 384.11 ± 131.63 | 322.35 ± 125.84 | 0.00 |
SOFA score | 1.69 ± 1.44 | 4.80 ± 3.20 | 0.00 |
Laboratory results, immediate postoperative | | | |
white blood cell count (/mL) | 12679.72 ± 6958.71 | 9528.31 ± 7016.89 | 0.00 |
hemoglobin (g/dL) | 12.59 ± 1.98 | 11.64 ± 2.04 | 0.00 |
hematocrit (%) | 36.92 ± 5.78 | 34.63 ± 5.50 | 0.00 |
platelet (109/L) | 244.22 ± 119.07 | 221.51 ± 114.75 | 0.02 |
blood urea nitrogen (mg/dL) | 19.04 ± 13.35 | 26.81 ± 16.48 | 0.00 |
creatinine (mg/dL) | 1.12 ± 1.78 | 1.35 ± 1.02 | 0.00 |
AST (U/L) | 35.00 ± 43.41 | 59.36 ± 203.29 | 0.52 |
ALT (U/L) | 27.27 ± 42.87 | 29.12 ± 71.10 | 0.01 |
Total bilirubin (mg/dL) | 0.93 ± 0.68 | 0.91 ± 0.74 | 0.80 |
albumin (g/dL) | 3.27 ± 0.62 | 2.57 ± 0.59 | 0.00 |
Body temperature (°C) | | | |
at the time of admission or ACS activation | 36.90 ± 0.74 | 36.97 ± 0.74 | 0.37 |
post-op, immediate | 36.45 ± 0.59 | 36.31 ± 0.51 | 0.01 |
peak body temperature (operation day) | 37.28 ± 0.64 | 37.06 ± 0.82 | 0.01 |
peak body temperature (first postoperative day) | 37.56 ± 0.47 | 37.48 ± 0.61 | 0.27 |
RBC transfusion | | | |
patients who received RBC before surgery | 4 (2.08) | 11 (9.17) | 0.01 |
amount during the operation (units) | 0.17 ± 0.65 | 0.75 ± 1.39 | 0.00 |
amount within 24 hrs after surgery (units) | 0.11 ± 0.48 | 0.41 ± 0.99 | 0.00 |
total amount after surgery (units) | 0.33 ± 0.93 | 1.89 ± 2.45 | 0.00 |
Patients received mechanical ventilation after surgery | 2 (1.04) | 42 (35.00) | 0.00 |
Patients received continuous renal replacement therapy after surgery | 4 (2.08) | 15 (12.50) | 0.00 |
Patients who developed delirium after surgery | 25 (13.02) | 74 (61.67) | 0.00 |
Values are presented as number (%), or mean ± standard deviation (range). |
ASA = American society of anesthesiologists; op = operation; ACS = acute care surgery; ER = emergency room; GS = general surgery; CT = computed tomography; ICU = intensive care unit; PF = ratio of arterial oxygen partial pressure to fractional inspired oxygen; SOFA = sequential organ failure assessment; AST = aspartate transaminase; ALT = alanine transaminase; APACH = acute physiology and chronic health evaluation; RBC = red blood cell |
After initial comparisons, univariate logistic regression identified significant variables, which were then analyzed via multivariate logistic regression to identiy independent risk factors for mortality and morbidity. Outcome-related variables like ICU stay and critical care level were excluded from multivariate analysis for lacking predictive relevance. As a result, i-SOFA and p-SOFA socres exhibited odds ratio (OR)s of 1.44 and 1.22, respectively, delineating them as independent predictive factors for mortality (Table 3). Moreover, the immediate postoperative BT, with an OR of 0.36, indicated that an elevation in BT is inversely associated with mortality risk. The ROC curve, presented in Fig. 1, with an AUC of 0.949, affirmed their substantial predictive accuracy. Table 4 reveals independent predictors for postoperative complications, indicating that patients undergoing open surgery, compared to laparoscopic surgery, experienced a 9.86-fold increase in the likelihood of complications. However, we suggest that the open surgery, in itself, cannot be the cause of increased morbidity. Instead, it seems the various clinical reasons for opting for open surgery over laparoscopic surgery—namely, hemodynamic instability and the preoperatively assessed severity of peritonitis—that allow for the prediction of higher morbidity rates. Furthermore, the risk of complications escalated by 2.56 times with each progression from none to localized to generalized intra-peritoneal contamination. The p-SOFA score showed a positive correlation with an OR of 1.82, while the immediate postoperative albumin level demonstrated an inverse relationship, with an OR of 0.22, suggesting that lower albumin levels significantly increase the risk of complications. The ROC curve for these variables is depicted in Fig. 2, with an AUC of 0.948, confirming their reliable predictive value.After initial comparisons, univariate logistic regression identified significant variables, which were then analyzed via multivariate logistic regression to identiy independent risk factors for mortality and morbidity. Outcome-related variables like ICU stay and critical care level were excluded from multivariate analysis for lacking predictive relevance. As a result, i-SOFA and p-SOFA socres exhibited odds ratio (OR)s of 1.44 and 1.22, respectively, delineating them as independent predictive factors for mortality (Table 3). Moreover, the immediate postoperative BT, with an OR of 0.36, indicated that an elevation in BT is inversely associated with mortality risk. The ROC curve, presented in Fig. 1, with an AUC of 0.949, affirmed their substantial predictive accuracy. Table 4 reveals independent predictors for postoperative complications, indicating that patients undergoing open surgery, compared to laparoscopic surgery, experienced a 9.86-fold increase in the likelihood of complications. However, we suggest that the open surgery, in itself, cannot be the cause of increased morbidity. Instead, it seems the various clinical reasons for opting for open surgery over laparoscopic surgery—namely, hemodynamic instability and the preoperatively assessed severity of peritonitis—that allow for the prediction of higher morbidity rates. Furthermore, the risk of complications escalated by 2.56 times with each progression from none to localized to generalized intra-peritoneal contamination. The p-SOFA score showed a positive correlation with an OR of 1.82, while the immediate postoperative albumin level demonstrated an inverse relationship, with an OR of 0.22, suggesting that lower albumin levels significantly increase the risk of complications. The ROC curve for these variables is depicted in Fig. 2, with an AUC of 0.948, confirming their reliable predictive value.
Table 3
Independent predictive factors for mortality.
Variables | OR | CI (95%) | P |
i-SOFA | 1.44 | (1.10, 1.88) | 0.01 |
p-SOFA | 1.24 | (1.00, 1.54) | 0.05 |
Body temperature, immediate postoperative | 0.36 | (0.13, 0.37) | 0.05 |
SOFA = sequential organ failure assessment; CI = confidence interval |
Table 4
Independent predictive factors for postoperative complications.
Variables | OR | CI (95%) | P |
Type of surgery (open vs. laparoscopy) | 9.86 | (4.24, 22.93) | 0.01 |
Extent of the intra-peritoneal contamination | 2.56 | (1.71, 3.84) | 0.00 |
p-SOFA | 1.82 | (1.53, 2.17) | 0.00 |
Serum albumin level, immediate postoperative | 0.22 | (0.13, 0.37) | 0.02 |
SOFA = sequential organ failure assessment; CI = confidence interval |