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Repeated Laparotomy for Postoperative Intra-abdominal Sepsis: An Analysis of Outcome Predictors

Repeated Laparotomy for Postoperative Intra-abdominal Sepsis: An Analysis of Outcome Predictors Abstract • To identify factors modifying the outcome of reoperation for intra-abdominal infection, we analyzed the management of 47 patients who underwent repeated laparotomy from July 1980 through July 1985. Overall mortality was 30% (14/47). Factors predictive of death were as follows: age greater than 60 years (86% mortality vs 21% mortality), preoperative vs no organ failure (57% vs 6%), multiple vs single abscess (53% vs 16%), and exploratory vs directed operative approach (39% vs 17%). Although the interval between the primary surgery and reoperation was similar between survivors (13 days) and nonsurvivors (14 days), five (36%) of 14 nonsurvivors were in septic shock and eight (57%) of 15 survivors showed evidence of organ failure prior to reoperation. The median survival period following reoperation in this group was only four days. Computed tomography (CT) and/or ultrasonography were performed to localize a source of infection in 24 patients. In nine (82%) of 11 patients, CT identified the abscess, while ultrasonography was positive in 15 (72%) of 21 patients. Neither the interval to operation nor the mortality was significantly different in patients diagnosed with CT and ultrasonography when compared with those who underwent exploration on the basis of clinical findings. To lower the mortality and to shorten the interval to reoperation in these high-risk patients, noninvasive diagnostic testing and confirmation by percutaneous sampling must be sought before the onset of clinical sepsis and organ failure. (Arch Surg 1987;122:702-706) References 1. Baue AE: Multiple, progressive, or sequential systems failure . Arch Surg 1975;110:779-781.Crossref 2. Fry DE, Pearlstein L, Fulton RL, et al: Multiple system organ failure . Arch Surg 1980;115:136-140.Crossref 3. Field TC, Pickleman J: Intra-abdominal abscess unassociated with prior operation . Arch Surg 1985;120:821-824.Crossref 4. Hinsdale JG, Jaffe EM: Reoperation for intra-abdominal sepsis . Ann Surg 1984;199:31-36.Crossref 5. Wang SMS, Wilson SE: Subphrenic abscess . Arch Surg 1977;112:934.Crossref 6. Norton LW: Does drainage of intra-abdominal pus reverse multiple organ failure? Am J Surg 1985;149:347-350.Crossref 7. Fry DE, Garrison RN, Neitsch RC, et al: Determinants of death in patients with intra-abdominal abscess . Surgery 1980;88:517-523. 8. Fry DE, Pearlstein L, Fulton RL, et al: Multiple system organ failure: The role of uncontrolled infection . Arch Surg 1980;115:136-149.Crossref 9. Pine RW, Wertz MJ, Lennard ES, et al: Determinants of organ malfunction or death in patients with intra-abdominal sepsis: A discriminant analysis . Arch Surg 1983;118:242-249.Crossref 10. Penninckx FM, Kerremans RP, Lauwers PM: Planned relaparotomies in the surgical treatment of severe, generalized peritonitis of intestinal origin . World J Surg 1983;7:762-766.Crossref 11. Norwood SH, Civetta JM: Abdominal CT scanning in critically ill surgical patients . Ann Surg 1985;202:166-175.Crossref 12. Roche J: Effectiveness of computed tomography in the diagnosis of intra-abdominal abscess . Med J Aust 1981;25:85-88. 13. Shapiro RL, Chiu LC, Yiu VS: Abdominal abscess: II. Diagnostic efficacy of computed tomography and comparison with ultrasonography . J Comput Tomogr 1978;2:211-215.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Repeated Laparotomy for Postoperative Intra-abdominal Sepsis: An Analysis of Outcome Predictors

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Publisher
American Medical Association
Copyright
Copyright © 1987 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1987.01400180084016
Publisher site
See Article on Publisher Site

Abstract

Abstract • To identify factors modifying the outcome of reoperation for intra-abdominal infection, we analyzed the management of 47 patients who underwent repeated laparotomy from July 1980 through July 1985. Overall mortality was 30% (14/47). Factors predictive of death were as follows: age greater than 60 years (86% mortality vs 21% mortality), preoperative vs no organ failure (57% vs 6%), multiple vs single abscess (53% vs 16%), and exploratory vs directed operative approach (39% vs 17%). Although the interval between the primary surgery and reoperation was similar between survivors (13 days) and nonsurvivors (14 days), five (36%) of 14 nonsurvivors were in septic shock and eight (57%) of 15 survivors showed evidence of organ failure prior to reoperation. The median survival period following reoperation in this group was only four days. Computed tomography (CT) and/or ultrasonography were performed to localize a source of infection in 24 patients. In nine (82%) of 11 patients, CT identified the abscess, while ultrasonography was positive in 15 (72%) of 21 patients. Neither the interval to operation nor the mortality was significantly different in patients diagnosed with CT and ultrasonography when compared with those who underwent exploration on the basis of clinical findings. To lower the mortality and to shorten the interval to reoperation in these high-risk patients, noninvasive diagnostic testing and confirmation by percutaneous sampling must be sought before the onset of clinical sepsis and organ failure. (Arch Surg 1987;122:702-706) References 1. Baue AE: Multiple, progressive, or sequential systems failure . Arch Surg 1975;110:779-781.Crossref 2. Fry DE, Pearlstein L, Fulton RL, et al: Multiple system organ failure . Arch Surg 1980;115:136-140.Crossref 3. Field TC, Pickleman J: Intra-abdominal abscess unassociated with prior operation . Arch Surg 1985;120:821-824.Crossref 4. Hinsdale JG, Jaffe EM: Reoperation for intra-abdominal sepsis . Ann Surg 1984;199:31-36.Crossref 5. Wang SMS, Wilson SE: Subphrenic abscess . Arch Surg 1977;112:934.Crossref 6. Norton LW: Does drainage of intra-abdominal pus reverse multiple organ failure? Am J Surg 1985;149:347-350.Crossref 7. Fry DE, Garrison RN, Neitsch RC, et al: Determinants of death in patients with intra-abdominal abscess . Surgery 1980;88:517-523. 8. Fry DE, Pearlstein L, Fulton RL, et al: Multiple system organ failure: The role of uncontrolled infection . Arch Surg 1980;115:136-149.Crossref 9. Pine RW, Wertz MJ, Lennard ES, et al: Determinants of organ malfunction or death in patients with intra-abdominal sepsis: A discriminant analysis . Arch Surg 1983;118:242-249.Crossref 10. Penninckx FM, Kerremans RP, Lauwers PM: Planned relaparotomies in the surgical treatment of severe, generalized peritonitis of intestinal origin . World J Surg 1983;7:762-766.Crossref 11. Norwood SH, Civetta JM: Abdominal CT scanning in critically ill surgical patients . Ann Surg 1985;202:166-175.Crossref 12. Roche J: Effectiveness of computed tomography in the diagnosis of intra-abdominal abscess . Med J Aust 1981;25:85-88. 13. Shapiro RL, Chiu LC, Yiu VS: Abdominal abscess: II. Diagnostic efficacy of computed tomography and comparison with ultrasonography . J Comput Tomogr 1978;2:211-215.Crossref

Journal

Archives of SurgeryAmerican Medical Association

Published: Jun 1, 1987

References