Audit of preoperative fluid resuscitation in perforation peritonitis patients using Physiological and Operative Severity Score for enUmeration of Mortality and Morbidity

CONTEXT: Debate continues regarding fluid (crystalloid vs. colloid) of choice for resuscitation. Physiological and Operative Severity Score for enUmeration of Mortality and Morbidity (POSSUM) may be used to compare the benefits of preoperative fluid resuscitation with crystalloids and colloids in peritonitis patients. AIMS: The aim of this study is to compare crystalloid and colloid for preoperative resuscitation using morbidity, mortality, length of hospital stay (LOS), and time taken to resuscitate as the outcome parameters. SETTINGS AND DESIGN: This was a prospective randomized clinical trial. SUBJECTS AND METHODS: One hundred and seven peritonitis patients were prospectively randomized to fluid resuscitation by crystalloid (Group A) and colloid (Group B) solutions. Physiological score component of POSSUM was recorded before and after fluid resuscitation; operative score component was recorded at discharge/death. These scores were then used to calculate the predicted morbidity and mortality before and after the fluid resuscitation. STATISTICAL ANALYSIS USED: Effect on morbidity and mortality were compared by repeated measure analysis of variance, and its significance was tested by Tukey's test. LOS and time taken to resuscitate were compared using unpaired t-test. Significance was taken at 5%. RESULTS: Fluid resuscitation improved mean predicted morbidity by 0.095 and 0.137 in Group A and Group B, respectively. Similarly, fluid resuscitation improved predicted mortality by 0.145 and 0.185 in Group A and Group B, respectively. These changes were statistically significant. Improvement in morbidity and mortality appeared greater in Group B. No difference was found in the two groups for LOS and time to resuscitate. CONCLUSIONS: Preoperative fluid resuscitation using either crystalloid or colloidal solutions decreases morbidity as well as mortality in peritonitis patients.