Prognostic Factors in Patients with Gastrointestinal Perforation under the Acute Care Surgery Model : A retrospective cohort study

Background 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. Materials and methods 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. Results 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 scores, and postoperative body temperatures. For morbidity, independent predictors were the extent of peritonitis, the surgical approach (open versus laparoscopic), postoperative albumin levels, and postoperative SOFA scores. These factors showed significant predictive accuracy for patient outcomes, as evidenced by the area under the receiver operating characteristic curve. Conclusion 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.