Patterns of organ failure in perforation peritonitis and its impact: a prospective observational study.

BACKGROUND

Perforation peritonitis remains one of the most common and severe surgical emergencies worldwide. Despite advances in perioperative care and intensive monitoring, organ failure associated with perforation peritonitis continues to contribute significantly to morbidity and mortality.

METHODS

A prospective study was conducted on 200 patients with perforation peritonitis undergoing emergency laparotomy. Patients were categorized based on the presence and progression of organ failure: no organ failure, single organ failure, multiple organ failure, treatment-resistant organ failure, and subsequently developed organ failure. These categories were correlated with 30-day perioperative outcomes. Student's t-test or Mann-Whitney were used to compare groups, Chi-square/Fisher's Exact Test for categorical variables and ANOVA or Wilcoxon Signed Rank test to analyze time-related data.

RESULTS

Among the 200 patients, only 12 (6%) had no organ failure, 22 (11%) had single organ failure, and 169 (84.5%) developed multiple organ failures. Overall, 52 patients (26%) died during hospitalization, while 148 (74%) survived. Mortality rates were significantly higher in patients with: multiple organ failure: 67/165 (40.6%) (P<0.001), treatment-resistant organ failure: 54/66 (81.85%) (P<0.001), subsequently developed organ failure: 60/81 (74%) (P<0.001). Preoperatively, respiratory and renal failures were the most common organ dysfunctions, while postoperatively, respiratory and hematological failures predominated. Postoperative complications according to the Clavien-Dindo classification were: grade II in 64 patients (43.2%), grade III in 11 (5.0%), grade IV in 77 (38.5%), and grade V in 48 (24%) (P<0.001).

CONCLUSIONS

Perforation peritonitis continues to pose a major clinical challenge due to its high morbidity and mortality, primarily driven by associated organ failures. Patients with multiple or treatment-resistant organ failures have significantly poorer outcomes.