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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.
Insights
Reoperation for intra-abdominal infection has high mortality. Advanced age, organ failure, multiple abscesses, and exploratory surgery predict death. Early noninvasive diagnosis is crucial for better outcomes.
Area of Science:
- Surgical outcomes research
- Infectious disease management
- Abdominal surgery complications
Background:
- Intra-abdominal infection often necessitates reoperation.
- Identifying factors influencing reoperation outcomes is critical for patient survival.
Purpose of the Study:
- To identify factors that modify the outcome of reoperation for intra-abdominal infection.
- To evaluate the role of diagnostic imaging in guiding reoperation decisions.
Main Methods:
- Retrospective analysis of 47 patients undergoing repeated laparotomy between 1980 and 1985.
- Assessment of patient demographics, clinical status, operative approach, and diagnostic imaging findings.
- Correlation of identified factors with patient mortality and survival outcomes.
Main Results:
- Overall mortality was 30%.
- Predictive factors for death included age >60 years, preoperative organ failure, multiple abscesses, and exploratory surgery.
- Computed tomography (CT) and ultrasonography showed high accuracy in abscess localization but did not significantly alter mortality compared to clinical exploration.
- Median survival post-reoperation was only four days.
Conclusions:
- Early noninvasive diagnostic testing and percutaneous sampling are essential before sepsis and organ failure onset.
- Timely diagnosis and targeted surgical intervention are key to reducing mortality in reoperation for intra-abdominal infections.