This study attempts to evaluate the prognostic value of the APACHE II scoring system in patients who underwent emergency operation for intrabdominal infection and to examine its usefullness in stratifying these patients according to their
surgical
risk
and as a potential aid in making rational and objective treatment decision. The records of 181 patients admitted to Department of Surgery, Gyeong-Sang National University Hospital and underwent emergency operations for perforative appendicitis(56
patients), peptic ulcer perforation(45 patients). small bowel perforation(23 patients), cholecystitis(18 patients), and cholangitis(39 patients) between March 1989 and March 1991 were reviewed.
1) The age of the patients showed even distribution, 2 to 82 years and peak range was 3rd decade.
2) The distribution of patients according to the APACHE II scores was 0 to 25 and the most patients was located between 0 and 5.
3) All of the deaths, except one who died during the induction of anesthesia had APACHE II scores higher than 10 and an increasing APACHE II score was associated with increased mortality rate(t value =-5.64, p<0.001).
4) The mean APACHE II socres of deaths was significantly higher than in those who survived(t value =52.5746, p<0.0001).
5) Although there was a correlation between age and APACHE II score(r=0.5763, p<0.0001), age accounted for about one-third(R2=0.33218) of the variability in the scores.
6) The mean APACHF II scores of postoperative 1 week was significantly lower that those of preoperation(t value =13.10 p<0.001).
7) Patients subjected to definitive ulcer operations had lower scores and lower mortality rates than those undergoing simple closure procedures(t value =5.59, p<0.001).
8) But, in the patients with high APACHE II scores higher than 10. All deaths were located, the mortality rates as the operative procedure of peptic ulcer was not verified due to the deficit of patient numbers for comparison.
We conclude that APACHE II scoring system is useful in measuring the severity of acute disease and predicting the outcome. When measured preoperatively, it accuratively stratifies these patients to various risk groups and should be used in
further
studies reporting various aspects of therapy of this condition. Our data examining the results of various procedures in subgroups of patients accurately stratified by the APACHE II score failed to support the superiority of one approach over
another.
Further studies are necessary to determine whether tailoring of the management to the severity of the patient's illness can improve results.
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