Analysis of risk factors for perioperative mortality in adults with small bowel perforation:a case controlled study

Abstract Background: Convincing evidence on the risk factors for perioperative death of small bowel perforation is lacking. This study aimed to investigate the etiologies of small bowel perforation and risk factors for perioperative mortality. Methods: Consecutive patients with small bowel perforation confirmed by emergency surgery at Zhongshan Hospital, Fudan University from January 2015 to December 2019 were analyzed retrospectively. Results: Of the 85 patients included in this study, ingestion of foreign bodies (19, 22.4%), lymphoma (17, 20.0%) and metastatic cancer (13, 15.3%) were the most common causes for small bowel perforation. Of them, 23 patients underwent perforation repair, 46 underwent segmental resection with primary anastomosis, and the other 16 underwent small-bowel ostomy. The operation time was the shortest for the perforation repair procedure ( P <0.001), and the hospital stay was the longest for patients undergoing ostomy ( P =0.010). Altogether 11 patients died postoperatively with a perioperative mortality rate of 12.9%. Serum procalcitonin ( P =0.037), blood lactate ( P <0.001) and APACHE II score ( P =0.0032) were higher in the dead than those in survivors. Conclusions: Foreign body ingestion, lymphoma and metastatic neoplasm were the most common causes for small bowel perforation. Serum precalcitonin, blood lactate and APACHE II score seem to be risk factors of perioperative mortality.†These authors contributed equally to this work