A prospective study of evaluation of peri-operative intra-abdominal pressure monitoring and its association with post-operative morbidity and mortality in emergency laparotomy

BACKGROUND AND OBJECTIVES: Abdominal compartment syndrome (ACS) and intra-abdominal hypertension (IAH) have been prominently identified among patients with surgical emergencies such as pancreatitis and intestinal obstruction, and among patients in Intensive Care Units (ICU). It is a proven fact that IAH is rampant among ICU patients. Around 18 to 80% ICU patients are affected by this entity and hence the increasing interest in this topic. Most of the body systems are affected by ACS and IAH, most markedly the renal, respiratory, cardiac and nervous systems. The prognosis of the patient depends on the flow of the blood to various organs which are ultimately affected by ACS/IAH. Timely recognition and appropriate treatment of ACS/IAH, either medical or surgical, plays a very important role in reducing the morbidity and mortality of patients. The aim of the study was to assess the relationship between peri-operative intra abdominal pressure and post-operative patient morbidity, (with special reference to kidney function and pulmonary atelectasis), and mortality. METHOD: Two groups of 50 surgical patients were selected. The experimental group had increased intra-abdominal pressure. The control group were selected from those undergoing elective surgery. In both groups, patients with factors which could cause increased intra-abdominal pressure like obesity were excluded. The preliminary details collected from patients included, name, age, sex, diagnosis, operative procedure planned, BMI. Presence or absence of diabetes mellitus, hypertension. Examination findings of pulse, blood pressure, respiratory rate, temperature and specific systemic examination of respiratory system, cardiovascular system and abdomen were noted. Laboratory tests done preoperatively and post operatively according to need were hemoglobin concentration, plasma urea, plasma creatinine and Chest X-Ray. Intra-abdominal pressure and urine output were monitored pre-operatively and at four hourly intervals in the post-operative period for 24 hours. The intravesical route of measuring the IAP was using the Foley’s method. Measurements were made at regular intervals, usually varying from 4 to 6hrs. Depending on the IAP the treatment modality was adjusted. Operative findings during laparotomy and the surgical procedure done were noted. Post-operative mechanical ventilation and re-laparotomy were followed up if needed. Also, cause of mortality was noted if the patient expired in spite of maximal supportive medical care. RESULTS: The results were documented and tabulated. The association of intra-abdominal pressure with renal dysfunction and pulmonary atelectasis was studied. The statistical significance was found out using the Chi square test. INTTEPRETATIONS AND CONCLUSION: It was found that the incidence of increased intra-abdominal pressure (emergency) was more among men. Urea and creatinine were significantly raised in the increased intra-abdominal pressure group when compared to the normal intra-abdominal pressure group at all time intervals (pre-operative, post – operative, 4th hour, 12th hour and 24th hour), thus indicating renal dysfunction in cases of increased intra abdominal pressure. There was no significant correlation between the urine output and the inra-abdominal pressure. There is a mild increase in the incidence of atelectasis post-operatively in cases of increased intra-abdominal pressure as compared to the group with normal intra abdominal pressure. The mortality was 0% in GRH