Validation of prognostic scoring systems for predicting 30-day mortality in perforated peptic ulcer disease.

OBJECTIVES: Perforations in Peptic Ulcer Disease are known to cause considerable morbidity and mortality. The objective of this study was to compare efficacy of known clinical parameters and three existing scoring systems in predicting 30-day mortality and determining mortality risk stratification based on risk factors. MATERIAL AND METHODS: This was a prospective observational study of 190 patients operated for perforated peptic ulcer over a period of 14 months at a 1500 bed tertiary care university hospital in Western India. RESULTS: The mortality rate observed was 18.95%. Elderly population, raised serum creatinine, time delay to surgery > 24 hours, preoperative shock and pre-existing medical illness were identified as risk factors for poor postoperative prognosis. The Area under curve for mortality prediction was 0.590 for ASA, 0.745 for Boey and 0.804 for PULP score. Mortality was best anticipated by a combination of raised serum creatinine levels, preoperative shock and delayed surgery by multivariate logistic regression analysis. CONCLUSION: Poor outcome was significantly higher in the elderly, patients with raised serum creatinine, preoperative shock, pre-existing medical illness and when the time delay to surgery was > 24 hours. In spite of the Boey score being more practical in application, PULP score proved to be a more precise indicator of mortality. A larger study inclusive of other Mortality Risk Prediction Models would help formulate a more accurate and population specific scoring system.

Audit of Postoperative Surgical Intensive Care Unit Admissions.

OBJECTIVE: The objective of this study was to conduct an audit of Surgical Intensive Care Unit (SICU) for identifying the admission risk factors and evaluating the outcomes of postoperative surgical patients. DESIGN: This was a prospective, observational study. SETTING: This study was conducted at SICU of a 1500-bedded tertiary care university hospital in Western India. SUBJECT AND METHODS: Two hundred and forty patients admitted to the SICU postoperatively over a period of 15 months. RESULTS: Planned and unplanned postoperative SICU admission rate was 4.45% and 0.09% of the 5284 patients operated. Indications for planned admissions included preoperative medical illnesses, anticipated blood loss, and anticipated mechanical ventilation while unpredicted intraoperative hypotension was the principal cause of unplanned admittance. Univariate analysis for two groups of the American Society of Anesthesiologists (ASA) physical status indicated that advanced age, high American College of Cardiology/American Heart Association (ACC/AHA) surgical risk, emergency surgery, planned admissions, and mortality were related to high ASA class. Analysis for ACC/AHA surgical risk showed association of high ACC/AHA surgical risk with advanced age, male gender, high ASA physical status, emergency surgery, planned admissions, and mortality. High mortality was observed in patients with SICU stay of >7 days (75.86%) and readmitted cases (72.73%). CONCLUSION: The need for postoperative critical care is significantly higher in males, elderly, patients with poor preoperative risk stratification scores, preexisting medical illness, major intraoperative hemorrhage, hypotension requiring inotropic support, perioperative respiratory problems and patients undergoing abdominal, trauma, and emergent surgeries. A larger study inclusive of other surgical subspecialties would aid in optimal decision-making for admissions to the SICU.

Giant hepatic hydatid cyst with sub-fascial extension treated by open minimally invasive surgery: a case report.

INTRODUCTION: Hepatic hydatid disease can be successfully treated by a variety of modalities. CASE PRESENTATION: We report a case of a 60 year old male with giant hepatic hydatid disease who presented with a huge cystic mass in the upper abdomen. Diagnosis was confirmed by serology, ultrasonography and CT scan. The patient was treated successfully by open minimally invasive surgery with minimum breaching of the peritoneal cavity using a laparoscopic trocar to evacuate the cyst. CONCLUSION: The use of a laparoscopic trocar through a small abdominal incision in selected patients with hepatic hydatid disease with subfascial extension can be a safe, minimally-invasive option of treatment.