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Reoperation for sepsis.

G W Machiedo, J Tikellis, W Suval

    The American Surgeon
    |March 1, 1985
    PubMed
    Summary
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    Clinical judgment, not lab tests, guides sepsis reoperation. Early surgery before organ failure improves outcomes, even with negative findings. Low lymphocyte counts and high creatinine predict fatal sepsis outcomes.

    Area of Science:

    • Surgical critical care
    • Infectious disease
    • Diagnostic imaging

    Background:

    • Sepsis reoperation requires accurate prediction of intraoperative findings and patient outcomes.
    • The role of clinical and laboratory parameters, including organ failure, in guiding reoperation for sepsis is not fully understood.

    Purpose of the Study:

    • To evaluate the predictive ability of clinical and laboratory tests for reoperation findings and outcomes in sepsis patients.
    • To assess the influence of multiple organ failure on these predictive parameters.

    Main Methods:

    • Retrospective study of 50 patients undergoing reoperation for sepsis.
    • Analysis of commonly available clinical and laboratory tests.
    • Evaluation of computed tomographic (CT) scanning accuracy.

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  • Correlation of findings with patient outcomes and organ failure status.

    • Main Results:

    • No laboratory test reliably predicted operative findings.
    • Computed tomographic scanning demonstrated 80% accuracy in predicting operative findings.
    • Low total lymphocyte count and high serum creatinine predicted fatal outcomes.
    • No specific organ failure pattern predicted a positive reexploration, though three-organ failure correlated with higher mortality.
    • Mortality was 18.2% for negative reexplorations versus 28.2% for positive ones.
    • No patient without organ failure died.

    Conclusions:

    • Laboratory tests are not useful for predicting intraoperative infection during sepsis reoperation.
    • Clinical judgment is paramount in deciding on reoperation for sepsis.
    • Reoperation before the onset of organ failure is advisable, as the risk of negative exploration is justified by potential benefits.