Determinants of postoperative mortality in patients with post-traumatic intestinal perforations at HEAL Africa tertiary Hospital in Goma

Abstract

Introduction: Post-traumatic intestinal perforations constitute a serious surgical emergency, associated with high mortality in resource-limited settings. This study aimed to analyze the determinants of postoperative mortality at HEAL Africa Hospital.

Methods: This was a retrospective analytical cross-sectional study conducted from January 1, 2022, to July 31, 2025, including 119 patients who underwent surgery for post-traumatic intestinal perforation. Statistical analysis included binary logistic regression with a significance threshold set at p < 0.05.

Results: Overall mortality was 36.1%. In multivariate analysis, the factors independently associated with death were: postoperative etiology (ORa=4.71 ; p=0.001), shock (ORa=3.86 ; p=0.001), malnutrition (ORa=4.78 ; p=0.010), operative time >90 minutes (ORa=3.48 ; p=0.013), relaparotomy (ORa=4.51 ; p=0.004), perforation diameter >1/3 (ORa=4.19 ; p<0.001), delayed feeding >72h (ORa=2.56 ; p=0.028), and two-stage closure followed by relaparotomy (ORa=3.17 ; p=0.005).

Conclusion: Postoperative mortality is primarily determined by initial clinical severity and certain therapeutic factors, highlighting the need for overall improvement in perioperative management.

Keywords: Determinants; Mortality; Intestinal perforations.