Monitoring of laboratory parameters and intra-abdominal pressure in early diagnosis of postoperative complications in patients with gynecological peritonitis

Aim. Identification of early postoperative complications in patients with gynecological peritonitis by monitoring laboratory parameters and intra-abdominal pressure. Material and methods. This study analyzed the results of complex diagnostics and treatment of 94 patients with gynecological peritonitis. All patients underwent emergency surgical interventions, which varied in their scope and method of implementation. For detailed monitoring of the postoperative course of the disease and timely identification of possible complications, the study cohort was stratified into two observation groups. The first group included 72 patients (76.6%) who did not experience any complications in the early postoperative period, while the second group consisted of 22 patients (23.4%) who developed intra-abdominal, systemic and wound complications of varying severity. Results. To assess the dynamics of the postoperative period, changes in laboratory parameters and the level of intra-abdominal pressure were monitored before the operation, as well as on the 1st, 3rd and 5th day after surgery. Intergroup analysis of clinical parameters did not reveal statistically significant differences when comparing the indicators both before surgery and during the first 24 hours of the postoperative period. The conducted assessment of the dynamics of the studied parameters between cohorts of patients with and without complications demonstrated comparable results at all observation points of the specified time interval. On the 3rd day after the intervention, significant differences were found in most parameters (p<0.001), with the exception of pyruvate, fibrinogen and intra-abdominal pressure levels. By the 5th day after the operation, the differences were statistically significant (p<0.001) for all studied parameters. The most pronounced differences were observed in the following parameters: C-reactive protein – 145.90 [141.75; 149.30] mg/l in the group with complications versus 14.40 [12.47; 16.73] mg/l in the group without complications; procalcitonin – 8.60 [5.80; 11.78] ng/ml versus 1.60 [1.27; 1.92] ng/ml; IL-6 – 148.80 [145.54; 155.68] pg/ml versus 30.00 [27.63; 34.52] pg/ml; and IAP level – 17.8 (0.41) mmHg versus 8.9 (0.29) mmHg. Conclusion. Thus, the analysis of the dynamics of changes in the levels of laboratory markers of blood serum and intra-abdominal pressure justifies the inclusion of CRP, procalcitonin, IL-6 and intra-abdominal pressure in the group of predictors. Their combined use allows us to assume the development of early postoperative complications as early as 3 days after surgery, which helps to choose the optimal treatment tactics.