Prognostic factors in patients with gastrointestinal perforation under the acute care surgery model : a retrospective cohort study

Gastrointestinal perforation (GIP) is a life-threatening condition that necessitates immediate surgical intervention. This study aims to identify prognostic factors in patients with GIP treated within a standardized acute care surgery (ACS) framework.

This single center retrospective cohort study analyzed patients diagnosed with GIP who underwent emergent surgery and were admitted to the intensive care unit between January 2013 and March 2023.

Among 354 patients, the mortality was 11%, and 38% of survivors experienced significant complications (Clavien-Dindo class III or higher). Independent prognostic factors for mortality included initial sequential organ failure assessment (SOFA) scores (at the time of admission or ACS activation), postoperative SOFA (p-SOFA) scores, and postoperative body temperatures. For morbidity, independent predictors were the extent of peritonitis, the open surgery, postoperative albumin levels, and p-SOFA scores. These factors showed significant predictive accuracy for patient outcomes, as evidenced by the area under the receiver operating characteristic curve. The Random Forest model identified p-SOFA scores and postoperative albumin levels as the most significant predictors for both survival and complications, with feature importances of 40.46% and 36.61% for survival, and 39.97% and 37.28% for complications, respectively. Postoperative body temperature also played a moderately important role, contributing 14.63% to mortality and 15.9% to morbidity predictions. Patients with a p-SOFA score ≥ 7, postoperative albumin ≤ 2, and body temperature ≤ 36 °C, as well as those with a p-SOFA score ≥ 10, albumin ≤ 2.9, and body temperature ≤ 36 °C, had a 100% mortality rate. These factors are critical indicators for predicting patient outcomes.

It is crucial to establish a system that ensures rapid preoperative work-up, accurate surgical intervention, and evidence-based postoperative critical care. Implementing such a system and assessing patient outcomes after surgery using the identified factors could provide a more detailed evaluation.