Study on the Preoperative and Postoperative Levels of Serum Lactate to Estimate Morbidity and Mortality in Cases of Bowel Perforation at a Tertiary Care Hospital in Jharkhand, India

TL;DR

This study examines how serum lactate levels before and after surgery can predict complications and mortality in patients with bowel perforation.

Contribution

The study introduces a systematic approach to monitoring serum lactate levels at specific postoperative time points to predict adverse outcomes in bowel perforation cases.

Findings

Elevated serum lactate levels were associated with prolonged hospital stays, surgical site occurrences, anastomotic leaks, and mortality.

Significant differences in lactate levels were observed from postoperative day 2 onward for most outcomes.

Preoperative lactate levels were significantly higher in patients who later died compared to those who survived.

Abstract

Introduction

Bowel perforation is a common emergency with high morbidity and mortality. The patient presented with acute abdomen, abdominal distention, obstipation, and frequent gas under the diaphragm on radiogram. Arterial blood gas (ABG) is one of the earliest investigations done in cases of suspected bowel perforation in the Emergency Room (ER), and includes serum lactate.

Objective

This study evaluates the role of sequential monitoring of serum lactate levels while ensuring a consistent timing of measurements and finding associations with prolonged hospital stay, surgical site occurrence, anastomotic leak, and mortality outcomes.

Methods

The study included 72 patients who presented to the healthcare facility within 72 hours of the onset of symptoms or occurrence. Continuous ABG was done before surgery and at POD 1, 2, 3, 5, and 7, and various parameters like age, sex, comorbidities, duration of presentation, site of perforation, prolonged hospital stay, surgical site occurrence, anastomotic leak, and mortality were noted in the form of tables.

Results

Analysis revealed that the mean serum lactate levels were generally higher in patients with prolonged hospital stays as compared to those without; however, there was no statistical significance at any time point. For surgical site occurrences (SSOs), there was no statistically significant difference in lactate levels between the two groups at Pre-Op, POD1, and POD2; however, significant differences were observed since POD3. For anastomotic leak, significant differences were observed at POD2. And for mortality, preoperatively, the mean lactate level in the mortality group was 5.91 mmol/L and 2.74 mmol/L in the non-mortality group, and this was statistically significant in all time periods.

Conclusion

Elevated serum lactate levels were consistently associated with adverse postoperative outcomes, including prolonged hospital stay, SSOs, anastomotic leaks, and mortality, with significance observed particularly from POD2 onward. Although not all differences were statistically significant, the trends suggest a meaningful clinical correlation. Routine lactate monitoring may serve as an important tool for the early detection of complications and risk stratification.

Figures