Background
Gastrointestinal (GI) perforation is a life-threatening surgical emergency that often results in severe peritonitis, sepsis, and multi-organ failure. Despite advancements in surgical techniques and perioperative care, postoperative anastomotic leaks and associated mortality remain significant concerns. This study aimed to evaluate the risk factors influencing postoperative leakage and mortality in patients undergoing surgery for GI perforations at a tertiary care center.
Methods
An analytical cross-sectional study was conducted at the Department of Surgery, RIMS, Ranchi, over 18 months. A total of 89 adult patients presenting with non-traumatic GI perforation involving the stomach, duodenum, jejunum, or ileum were included. Patients with esophageal, colonic, iatrogenic, traumatic, or malignant perforations were excluded. “Clinical, demographic, biochemical, and surgical data were collected and analyzed using statistical methods to identify associations with postoperative leaks and 30-day mortality.
Results
The incidence of postoperative leaks was 19.1%, with a mortality rate of 20.2%. Statistically significant risk factors for postoperative leaks included advanced age (p=0.013), delayed presentation (p=0.001), pre-existing acute kidney injury (p=0.013), gastric site of perforation (p=0.031), and the type of surgery performed (p=0.047). Biochemical predictors such as elevated CRP and WBC counts and low serum albumin levels were strongly associated with leak occurrence (p<0.001). Postoperative leaks were significantly correlated with higher mortality (82.35% vs. 5.56%, p<0.001).
Conclusion
Postoperative anastomotic leak significantly increases the risk of mortality in patients with GI perforation. Early diagnosis, risk stratification using clinical and biochemical markers, and appropriate surgical planning are essential to improve outcomes.
Recommendation
Early identification of high-risk patients and timely surgical intervention, along with preventive strategies like protective stoma and improved perioperative care, are recommended to reduce postoperative leaks and mortality
