Introduction: Major abdominal surgery is still a great contributor to postoperative morbidity and mortality in developing countries. Major abdominal surgery, through tissue manipulation and the physiological stress it causes, leads to hypoperfusion. Hypoperfusion has an impact on postoperative morbidity and mortality warranting the need for its early recognition. Lactate, an anion capable of being used to detect hypoperfusion, is under utilized in Uganda. As a result its capacity of being a prognostic tool in patients following abdominal surgery is unknown. Objective: To investigate the association between elevated serum lactate and outcomes (in-hospital mortality, SSI and length of hospital stay) in patients following major abdominal surgery at MNRH. Methodology: A prospective observational cohort study. A total of 246 eligible patients with a diagnosis leading to major abdominal surgery were recruited. Stratified sampling with consecutive sampling in the sub groups was done till desired sample size was achieved. Demographic and perioperative data were collected serum lactate levels were measured at induction and immediately after surgery with serial measurements being done after 12, 24 hours post operatively. Participants were followed up to assess outcomes i.e in-hospital mortality, Surgical Site Infections (SSI) and length of hospital stay. Data analysis was done using STATA version 14.0. Results: A total of 130 patients (52.8%) had elevated serum lactate levels. Elevated serum lactate predicted in-hospital mortality and surgical site infection. The accuracy of elevated serum lactate to predict mortality with AUROC of 0.7898 was exhibited by the 24 hour lactate values. Elevated serum lactate predicted surgical site infection accurately with AUROC 0.6432. Length of hospital stay is strongly associated with elevated serum lactate with p-value of 0.043. Patients with elevated serum lactate on average have a longer length of hospital stay at 5.34±0.69. Conclusion: Elevated serum lactate was associated with in-hospital mortality, surgical site infection and longer length of hospital stay. Serum lactate levels done at 24 hours were most predictive mortality and surgical site infection compared to the other perioperative serum lactate levels. Through intravenous fluid administration, lowering of serum lactate levels was associated with improved outcomes.

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