# Risk stratification of residual abscess after surgical treatment for gastroduodenal perforation

## TL;DR

This study identifies risk factors for residual abscesses after gastroduodenal perforation surgery and proposes a risk stratification strategy to improve patient management.

## Contribution

The study introduces a novel risk stratification model for residual abscesses based on preoperative and postoperative factors.

## Key findings

- Current use of nonsteroidal antiinflammatory drugs, cancer chemotherapy, and preoperative renal dysfunction are independent predictors of residual abscesses.
- A scoring model based on these three factors correlates with abscess likelihood, with higher risk scores indicating higher incidence.
- C-reactive protein on postoperative day 5 is the best early predictor of residual abscesses.

## Abstract

Residual abscess is a major complication after emergency surgery for gastroduodenal (GD) perforation. However, there is little evidence regarding potential risk factors contributing to its development. Establishing a risk stratification strategy would be valuable for the entire management process.

This single‐center, retrospective study analyzed 115 consecutive patients who underwent surgery for GD perforation between 2010 and 2023 at a secondary emergency care hospital. Patients were divided into two groups based on the presence or absence of residual abscesses. Potential risk factors for abscess formation were evaluated from various aspects.

The incidence of residual abscesses was 19.1% (22 of 115). Multivariable analysis revealed that current use of nonsteroidal antiinflammatory drugs (odds ratio [OR] 3.76, p = 0.037), cancer chemotherapy (OR 13.56, p = 0.005), and preoperative renal dysfunction (OR 4.72, p = 0.018) were independent predictors. A potential scoring model could be created using these three parameters, and the number of risk factors correlated with the likelihood of developing a residual abscess (0 vs. 1 vs. ≥2; 6.2% vs. 29.4% vs. 50.0%, p < 0.001). From a bacteriological point of view, the presence of Enterococcus in the ascites culture was closely related to its occurrence with 100% probability. Moreover, regarding early detection of this complication, C‐reactive protein on postoperative d 5 had the highest predictive ability with an area under the curve of 0.818.

The risk of residual abscess formation after surgical treatment of GD perforation can be assessed utilizing both preoperative and postoperative information.

This report highlights the optimal risk stratification strategy for residual abscesses after surgical gastroduodenal (GD) perforations treatment. Since the pathogenesis of residual abscess is likely to be multifactorial, careful evaluation of potential risk factors from all angles will help us to provide prompt and precise treatment to patients, including medication history, renal function, microorganisms, and inflammatory biomarkers.