A retrospective cohort study of perioperative prognostic factors associated with intra-abdominal sepsis

CONTEXT: Intra-abdominal sepsis following laparotomy for acute abdomen remains still a challenging condition. The understanding of various perioperative risk factors by anesthesiologists are crucial in optimum management these patients. AIMS: The objective of this study is to assess the perioperative risk factors, which predicts the outcome of treatment. SETTINGS AND DESIGN: This retrospective observational study of 603 patients who underwent Laparotomies between March 2012 and March 2015 at our University Medical College. Of 603 patients, 52 consecutive patients with intra-abdomen sepsis who underwent surgical procedures and admitted in Intensive Care Unit (ICU) were selected and analyzed for prognostic risk factors in relation to severity of the disease. SUBJECTS AND METHODS: 52 consecutive patients who developed intra-abdominal sepsis following laparotomy was allocated one of two groups; Group Sepsis, patients with peritonitis without systemic hypotension (mean arterial pressure [MAP] >60 mm of Hg); and Group septic shock, patients with peritonitis with systemic hypotension (mean arterial pressure [MAP] <60 mm of Hg) and patients were analyzed for prognostic risk factors STATISTICAL ANALYSIS USED: Categorical variables were analyzed by using Fisher's exact (two-tail) test and continuous variable were analyzed by using Mann–Whitney (two-tail) U-test. RESULTS: Out of 603 patients who underwent laparotomy 52 patients developed an intra-abdominal septic complication. Of these 52 cases studied 28 patients developed septic shock and required a longer duration of admission in ICU and more inotropic support. Preoperative albumin and hematocrit level were significantly low in septic shock patients as compared to the patients with sepsis without systemic hypotension. PaCO(2): FiO(2) was also significantly low in these patients. CONCLUSIONS: Preoperative low hematocrit, low albumin level, and delay in laparotomy more than 72 h were also associated with adverse outcome in the patients with intra-abdominal sepsis. Clinicians should maintain equipoise on this topic pending prospective randomized clinical trials.