A retrospective cross-sectional study of pattern and predictors of outcome in patients with secondary generalized peritonitis in two referral hospitals in AddisAbaba, Ethiopia

Objectives = The main objective of this study is to determine the pattern and predictors of outcome in patients with secondary Generalized peritonitis in two referral hospitals in AddisAbaba, Ethiopia. Design = The study design is cross sectional retrospective study over the period of four and half years. It involved patients with secondary generalized peritonitis on the two hospitals to determine the pattern and etiologies of secondary peritonitis. Various clinical, epidemiological, laboratory and intraoperative variables are analyzed to detect the ones that have significant relation with patients’ outcome. P value of <0.05 with confidence interval of >95% is used to determine significance. Setting = Two governmental referral hospitals in the capital of Ethiopia. Participants = patients with secondary generalized peritonitis presenting to the emergency department over the study period. Results = A total of 235 patients from which 78.3% are males and 21.7% are females were enrolled to the study. Perforated peptic ulcer disease and perforated appendicitis are commonest etiologies accounting for about 79.1 of total cases and tumor perforation accounted for 5.1%. Mortality was determined to be 6.8 % the commonest cause being multi-organ failure secondary to septic shock of gastrointestinal focus. 21.7% of the total patients have a complicated post-operative course. Post-operative abdominal collection occurred in 5.6 % of the total patients followed by pneumonia which occurred around 5.2 % of post op patients. Superficial and deep surgical site infections were detected in 4.2% and 2.5% of total patients respectively. 6.8 % of patients had reoperation with the commonest indication of post-operative abdominal collection and complete wound dehiscence. prolonged hospital stay was recorded in 25.1 % of cases. Through multivariate logistic regression age of patients greater than 60 years and duration of surgery greater than 2 hours has strong correlation with mortality of the patients. Both systolic and diastolic hypotension are associated with increased mortality predicting worsened outcome for the patients. From the laboratory variables White blood cell count less than 4000 per microliter predicted the demise of a patient. Anemic patients also have quite increased mortality necessitating its correction prior to surgical intervention. Intraoperative vasopressor requirement is greatly associated with early mortality. 5.5 % of patients had comorbidities which were linked to increased mortality. Conclusion = Secondary generalized peritonitis is still the commonest reason for emergency surgical visit and is associated with high morbidity and mortality. Perforated peptic ulcer disease and perforated appendicitis accounted for most cases of secondary generalized peritonitis. The occurrence of complications and mortalities is associated with various epidemiological, clinical, laboratory and intraoperative factors and their interactions. Surgical therapy with Intensive care which is tailor made for each patient should be delivered to for the best outcome.