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Predictors of outcome in patients with postoperative intra-abdominal infection
1Department of General Surgery, Nordwest-Krankenhaus Sanderbusch, Sande, Germany.
Objective:
To assess those factors which predict prognosis in patients with postoperative intra-abdominal infections.
Design:
Open study.
Setting:
Teaching hospital, Germany.
Subjects:
48 patients who developed postoperative intra-abdominal infections between January 1989 and July 1993.
Interventions:
Calculation of APACHE II score and Mannheim Peritonitis Index (MPI). Evaluation of single components of APACHE II score.
Main Outcome Measure:
Correlation between outcome and these variables together with time between first operation and reexploration, whether the source of infection was eliminated, whether the abdomen was managed by a closed or open technique, and the extent and origin of the infection.
Results:
Both APACHE II and MPI predicted outcome. Of the single components of the APACHE II score studied, those that correlated significantly with outcome were the Glasgow coma scale and chronic health evaluation (p < 0.001 in each case), and age (p < 0.01). The extent of peritonitis (local or diffuse) correlated with the APACHE II score and with outcome (p < 0.001 in each case). The time that elapsed before reoperation was significantly shorter in patients who died (8 days) than in those who survived (16 days, p = 0.03). In 37 of the patients the source of infection was eliminated resulting in 7 deaths (19%); all 11 of those in whom it was not eliminated died. Of the 35 patients who underwent closed treatment of the abdominal cavity 8 died (23%) compared with 10 of the 13 who underwent etappenlavage (77%, p < 0.01). Patients who underwent closed treatment, however, had fewer risk factors. No other variable correlated with outcome.
Conclusions:
Outcome of patients with postoperative intra-abdominal infections correlates significantly with APACHE II and MPI, and in particular with age, Glasgow coma scale, and chronic health evaluation. It also correlates with time between the first and subsequent operations. Elimination of the source of infection and closed treatment of the abdominal cavity are associated with less risk factors and increased survival.
Insights
Prognosis in postoperative intra-abdominal infections is predicted by APACHE II and Mannheim Peritonitis Index scores. Key factors include age, Glasgow coma scale, chronic health evaluation, and timely elimination of infection sources.
Area of Science:
- Surgical Infections
- Prognostic Factors
- Critical Care Medicine
Background:
- Postoperative intra-abdominal infections pose significant challenges in patient management.
- Identifying predictive factors for prognosis is crucial for optimizing treatment strategies.
Purpose of the Study:
- To evaluate prognostic indicators for patients experiencing postoperative intra-abdominal infections.
- To assess the predictive value of APACHE II and Mannheim Peritonitis Index (MPI) scores.
Main Methods:
- An open study was conducted involving 48 patients with postoperative intra-abdominal infections at a German teaching hospital.
- APACHE II and MPI scores were calculated, along with an analysis of individual APACHE II components.
- Outcome correlations were examined with various factors including time to reoperation, infection source elimination, and abdominal cavity management techniques.
Main Results:
- Both APACHE II and MPI scores significantly predicted patient outcomes.
- Age, Glasgow coma scale, and chronic health evaluation were significant predictors within the APACHE II score.
- Elimination of the infection source and closed abdominal cavity treatment were associated with improved survival rates.
Conclusions:
- APACHE II and MPI scores are significant prognostic tools for postoperative intra-abdominal infections.
- Early intervention, including source elimination and appropriate surgical techniques, improves patient survival.
- Specific patient factors like age and neurological status are critical in predicting outcomes.