Evaluation of the Severity and Prediction of Postoperative Infection for Patients with Peritonitis or Abdominal Trauma, by a Scoring System

Takashi Kodama, Takashi Yokoyama*, Yoshio Takesue, Mitsuaki Okita, Atsushi Nakamitsu, Eiso Hiyama*, Yuuji Imamura, Takahiro Santo, Yoshiaki Murakami, Hiroaki Tsumura, Toshiaki Hirata, Katsunari Miyamoto, Naokuni Tatsumoto, Yuichirou Matsuura

First Department of Surgery, Hiroshima University School of Medicine
*Department of General Medicine, Hiroshima University School of Medicine

To evaluate the severity and predict postoperative infection for patients with peritonitis and abdominal trauma we determined the severity score according to our scoring system (modified acute physiologic and chronic health evaluation II [APACHEII]). The severity in 95 patients (74 with peritonitis, 21 with abdominal trauma) graded by this system. The scores ranged from 0 to 13. Seventy percent of the patients had a score of less than 3 and maximum number, 27, of the patients were distributed at 0 point. The average score in each disease was 0.7 perforating appendicitis [n=19]), 1.9 (perforating upper gastrointestinal tract [n=26]), 4.1 (perforating lower intestinal tract [n=29]) and 4.4 (abdominal trauma [n=21]). Of the 95 patients, 35 had complicating with postoperative infections. Eight patients died of postoperative infections. The mean value of the severity score was 1.4 (no postoperative infections [n=60]), 4.9 (postoperative infections [n=27]) and 7.5 (non survivors [n=8]). The value for the each group was significantly different. Postoperative infections were observed in 80% of the patients with a score of 5 or more and in 24.5% less than 5. A score was closely correlated with the subsequent risk of postoperative infections. Mortality was 40% of all patients with a severity score greater than 8. The rate of the prediction of the fatal outcome was low. When an emergency abdominal operation is needed, we evaluate the severity and predict the postoperative infections using our scoring system. Consideration of the score leads to selection of the appropriate operation method and postoperative chemotherapy. This reasonable selection procedure gave us good results.

Key words
severity score, prediction of the mortality, postoperative infections, selection of the operation methods in surgical emergency

Reprint requests
Takashi Kodama First Department of Surgery, Hiroshima University School of Medicine
1-2-3 Kasumi, Minami-ku, Hiroshima, 734 JAPAN

Accepted
November 11, 1992

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