Sung Kiyoung, Hwang Sanguk, Lee Jaeheon, Cho Jinbeom
Department of Surgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Department of Artificial Intelligence, The Catholic University of Korea, Bucheon, Republic of Korea.
BMC Surg. 2024 Dec 21;24(1):406. doi: 10.1186/s12893-024-02687-7.
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.
胃肠道穿孔（GIP）是一种危及生命的疾病，需要立即进行手术干预。本研究旨在确定在标准化急性护理手术（ACS）框架内接受治疗的GIP患者的预后因素。
这项单中心回顾性队列研究分析了2013年1月至2023年3月期间诊断为GIP并接受急诊手术且入住重症监护病房的患者。
在354例患者中，死亡率为11%，38%的幸存者出现了严重并发症（Clavien-Dindo III级或更高）。死亡率的独立预后因素包括初始序贯器官衰竭评估（SOFA）评分（入院时或ACS启动时）、术后SOFA（p-SOFA）评分和术后体温。对于发病率，独立预测因素是腹膜炎的程度、开放手术、术后白蛋白水平和p-SOFA评分。这些因素对患者预后具有显著的预测准确性，受试者工作特征曲线下面积证明了这一点。随机森林模型确定p-SOFA评分和术后白蛋白水平是生存和并发症的最重要预测因素，生存的特征重要性分别为40.46%和36.61%，并发症的特征重要性分别为39.97%和37.28%。术后体温也起到了中等重要的作用，对死亡率的贡献为14.63%，对发病率预测的贡献为15.9%。p-SOFA评分≥7、术后白蛋白≤2且体温≤36°C的患者，以及p-SOFA评分≥10、白蛋白≤2.9且体温≤36°C的患者，死亡率为100%。这些因素是预测患者预后的关键指标。
建立一个确保快速术前检查、准确手术干预和循证术后重症监护的系统至关重要。实施这样一个系统并使用确定的因素评估术后患者预后可以提供更详细的评估。
