Role of Modified Apache II Score for Assessment of Peritonitis due to Hollow Viscus Perforation
Author(s): Deepak Ranjan Nayak, Abinash kumar Panda, Ajaya kumar Sahu, LV Gouri* and Ashish Kumar Behera
Abstract
Background: APACHE II is one of the most commonly used scoring systems to know the severity of the disease. There is very limited study regarding the importance of APACHE II score in the prediction of outcomes arising from hollow viscus perforation and peritonitis. The mortality and morbidity in patients with perforative peritonitis remain high. APACHE II is considered to be a better scoring system for predicting the outcome of abdominal sepsis. Objective: To understand the importance of the APACHE II score in predicting the severity and outcome of patients with hollow viscus perforation. Material and methods: This was a prospective, observational study done over a period from October 2017 to October 2019 at the dept. of surgery, SCB medical college, Cuttack. Sixty patients of perforation peritonitis who had undergone laparotomy were included in the study. APACHE II scores were assessed and recorded for all patients. The accuracy of outcome prediction by the APACHE II scoring system was estimated by using the ROC curve and Pearson correlation test. Results: Per formative peritonitis was more common within the age bracket of 31-40 years with a male to female ratio of 5:1. Duodenum constituted the most common site of GI perforation followed by the ileum and appendix. Surgical site infection (SSI) was the most common postoperative complication which was encountered in 20 patients. All the patients having an APACHE II score of more than 15 developed systemic complications. The highest deaths (63.6%) were seen in a patient with an APACHE II score of 15-20. The mean APACHE II score between the survivors and non-survivors (8.9 vs. 17.6) showed a statistical significance. Conclusions: From this study, it can be better concluded that the modified APACHE II score can be used for the prediction of the outcomes in patients with peritonitis due to hollow viscus perforation. A modified APACHE II score of more than 15 is associated with a very high risk of systemic complications in the post-operative period which results in increased morbidity and mortality.