Laparotomy for abdominal sepsis in the critically ill

Area of Science:

• Critical Care Medicine
• Surgical Gastroenterology
• Infectious Diseases

Background:

• Severe abdominal sepsis is a critical condition requiring intensive care unit (ICU) management.
• Laparotomy is frequently employed, but the impact of multiple surgical interventions on outcomes is not fully elucidated.

Purpose of the Study:

• To evaluate the outcomes of patients with severe abdominal sepsis requiring multiple laparotomies in the ICU.
• To assess the relationship between the number of operations and patient survival.
• To explore the effectiveness of surgical interventions and the timing of diagnosis.

Main Methods:

• Retrospective analysis of 125 patients admitted to the ICU with severe abdominal sepsis over three years.
• Data collection included demographics, APACHE II scores, number of laparotomies, and survival rates.
• Analysis of surgical outcomes, including therapeutic success and improvement within 48 hours.

Main Results:

• 60 patients (48%) required further laparotomy, with a median age of 67 years and high APACHE II scores.
• Survival to ICU discharge was 42% and to hospital discharge was 32%.
• Survival significantly decreased with an increasing number of ICU operations (P=0.01); only 9% of patients not improved by the first operation survived (P<0.0001).

Conclusions:

• Multiple operations for abdominal sepsis in the ICU are associated with diminishing returns and reduced survival.
• Eradication of sepsis source was a prerequisite for survival but less frequent with more operations.
• Delayed surgical diagnosis increased the need for subsequent procedures, highlighting the need for alternative surgical strategies.