Study on the Preoperative and Postoperative Levels of Serum Lactate to Estimate Morbidity and Mortality in Cases of Bowel Perforation at a Tertiary Care Hospital in Jharkhand, India.

Introduction Bowel perforation is a common emergency with high morbidity and mortality. The patient presented with acute abdomen, abdominal distention, obstipation, and frequent gas under the diaphragm on radiogram. Arterial blood gas (ABG) is one of the earliest investigations done in cases of suspected bowel perforation in the Emergency Room (ER), and includes serum lactate.  Objective This study evaluates the role of sequential monitoring of serum lactate levels while ensuring a consistent timing of measurements and finding associations with prolonged hospital stay, surgical site occurrence, anastomotic leak, and mortality outcomes. Methods The study included 72 patients who presented to the healthcare facility within 72 hours of the onset of symptoms or occurrence. Continuous ABG was done before surgery and at POD 1, 2, 3, 5, and 7, and various parameters like age, sex, comorbidities, duration of presentation, site of perforation, prolonged hospital stay, surgical site occurrence, anastomotic leak, and mortality were noted in the form of tables. Results Analysis revealed that the mean serum lactate levels were generally higher in patients with prolonged hospital stays as compared to those without; however, there was no statistical significance at any time point. For surgical site occurrences (SSOs), there was no statistically significant difference in lactate levels between the two groups at Pre-Op, POD1, and POD2; however, significant differences were observed since POD3. For anastomotic leak, significant differences were observed at POD2. And for mortality, preoperatively, the mean lactate level in the mortality group was 5.91 mmol/L and 2.74 mmol/L in the non-mortality group, and this was statistically significant in all time periods. Conclusion Elevated serum lactate levels were consistently associated with adverse postoperative outcomes, including prolonged hospital stay, SSOs, anastomotic leaks, and mortality, with significance observed particularly from POD2 onward. Although not all differences were statistically significant, the trends suggest a meaningful clinical correlation. Routine lactate monitoring may serve as an important tool for the early detection of complications and risk stratification.