Surgical Outcomes in Adults with Acute Small Bowel Perforation and Risk Factors for Mortality: A Single-Center Retrospective Cohort Study.

Abstract

\n Background Small bowel perforation is a life-threatening surgical emergency even after immediate surgical intervention, while the surgical outcomes are rarely discussed in the literature due to relatively low incidence. This study aimed to investigate the surgical outcomes of small bowel perforation and risk factors for mortality.Methods Consecutive patients with small bowel perforation confirmed by emergency surgery at Zhongshan Hospital, Fudan University from February 2011 to May 2020 were analyzed retrospectively. Clinical features, laboratory indicators, surgical findings and pathology were reviewed based on the medical records. Results 199 patients were included in this study, of which 50 patients underwent perforation repair, 117 underwent primary anastomosis, and the other 32 underwent small bowel ostomy. 52.3% (104/199) patients transferred to ICU just after surgery and malignant tumor was the leading cause responsible for perforation in these patients (40.4%, 42/104), although foreign bodies ingestion (27.1%, 54/199) were most common for all cases in this study. The overall postoperative morbidity and mortality rate were 54.3% (108/199) and 10.6% (21/199) respectively, which were higher in the ICU group (74.0% (77/104) and 19.2% (20/104), respectively). Malignant tumor related perforation (OR, 3.567; 95%CI, 1.175-10.823; P=0.025) and high postoperative arterial blood lactate (LAC) level (OR,1.583; 95%CI, 1.127-2.225; P=0.008) were independent risk factors for post-operative mortality for patients transferred to ICU. Conclusion Small bowel perforation is associated with significant morbidity and mortality rates after emergency surgery, especially for patients transferred to ICU. Malignant tumor related perforation, as well as higher postoperative blood lactate had increased risk of postoperative mortality.