Prognostic Factors of the Mortality of Postoperative Intraabdominal Infections

Overview

Journal Infection

Date 2010 Apr 16

PMID 20393782

Citations 18

Authors

N Torer

K Yorganci

D Elker

I Sayek

Affiliations

Soon will be listed here.

Abstract

Purpose: We investigated the relationship between the prognostic factors of postoperative peritonitis and mortality.

Methods: Data from 56 patients re-operated for postoperative secondary peritonitis in our hospital between 1991 and 2001 were collected retrospectively. Demographic features, comorbidity, malignancy, organ failure, type and timing of the primary operation, intraoperative findings, etiology of postoperative peritonitis, number of relaparotomies, source control failure, Mannheim peritonitis index (MPI), and mortality were noted. The time intervals between the first operation and relaparotomy, and between symptom onset and the second operation were also noted.

Results: The overall mortality rate was 32% (n = 18). Organ failure (p = 0.001), time elapse between symptoms and the second operation (p = 0.046), severity of peritonitis (p = 0.035), source control failure (0.047), and MPI scores (p = 0.032) were significantly related with the mortality of postoperative peritonitis in a univariate analysis. MPI score >30 had a higher mortality rate.

Conclusion: Delaying relaparotomy for more than 24 h and presence of organ failure result in higher mortality.

Citing Articles

Source control in emergency general surgery: WSES, GAIS, SIS-E, SIS-A guidelines.

Coccolini F, Sartelli M, Sawyer R, Rasa K, Viaggi B, Abu-Zidan F World J Emerg Surg. 2023; 18(1):41.

PMID: 37480129 PMC: 10362628. DOI: 10.1186/s13017-023-00509-4.

Korean Guidelines for Use of Antibiotics for Intra-abdominal Infections in Adults.

Yoon Y, Moon C, Kim J, Heo S, Lee M, Lee S Infect Chemother. 2023; 54(4):812-853.

PMID: 36596690 PMC: 9840951. DOI: 10.3947/ic.2022.0156.

WSES/GAIS/SIS-E/WSIS/AAST global clinical pathways for patients with intra-abdominal infections.

Sartelli M, Coccolini F, Kluger Y, Agastra E, Abu-Zidan F, Abbas A World J Emerg Surg. 2021; 16(1):49.

PMID: 34563232 PMC: 8467193. DOI: 10.1186/s13017-021-00387-8.

Tertiary peritonitis: considerations for complex team-based care.

Bass G, Dzierba A, Taylor B, Lane-Fall M, Kaplan L Eur J Trauma Emerg Surg. 2021; 48(2):811-825.

PMID: 34302503 PMC: 8308068. DOI: 10.1007/s00068-021-01750-9.

Clinical evaluation of the Mannheim Prognostic Index in post-operative peritonitis: a prospective cohort study.

Neri A, Fusario D, Marano L, Savelli V, Bartalini Cinughi de Pazzi A, Cassetti D Updates Surg. 2020; 72(4):1159-1166.

PMID: 32578039 DOI: 10.1007/s13304-020-00831-5.

References

Billing A, Frohlich D, Mialkowskyj O, Stokstad P, Schildberg F . [Treatment of peritonitis with staged lavage: prognostic criteria and course of treatment]. Langenbecks Arch Chir. 1992; 377(5):305-13. DOI: 10.1007/BF00189477. View

Wahl W, Minkus A, Junginger T . [Prognostically relevant factors in intra-abdominal infection]. Langenbecks Arch Chir. 1992; 377(4):237-43. DOI: 10.1007/BF00210281. View

Bohnen J, Marshall J, Fry D, Johnson S, Solomkin J . Clinical and scientific importance of source control in abdominal infections: summary of a symposium. Can J Surg. 1999; 42(2):122-6. PMC: 3788974. View

Robledo F, Luque-de-Leon E, Suarez R, Sanchez P, de-la-Fuente M, Vargas A . Open versus closed management of the abdomen in the surgical treatment of severe secondary peritonitis: a randomized clinical trial. Surg Infect (Larchmt). 2007; 8(1):63-72. DOI: 10.1089/sur.2006.8.016. View

Mulier S, Penninckx F, Verwaest C, Filez L, Aerts R, Fieuws S . Factors affecting mortality in generalized postoperative peritonitis: multivariate analysis in 96 patients. World J Surg. 2003; 27(4):379-84. DOI: 10.1007/s00268-002-6705-x. View

Schein M . Surgical management of intra-abdominal infection: is there any evidence?. Langenbecks Arch Surg. 2002; 387(1):1-7. DOI: 10.1007/s00423-002-0276-z. View

Ohmann C, Wittmann D, Wacha H . Prospective evaluation of prognostic scoring systems in peritonitis. Peritonitis Study Group. Eur J Surg. 1993; 159(5):267-74. View

Ohmann C, Hau T . Prognostic indices in peritonitis. Hepatogastroenterology. 1997; 44(16):937-46. View

Altunbay S, Bleiler H, Heil T . [Postoperative peritonitis. Patients, causes, therapy, prognosis]. Fortschr Med. 1982; 100(13):560-4. View

10.

Lamme B, Boermeester M, Reitsma J, Mahler C, Obertop H, Gouma D . Meta-analysis of relaparotomy for secondary peritonitis. Br J Surg. 2002; 89(12):1516-24. DOI: 10.1046/j.1365-2168.2002.02293.x. View

11.

Pacelli F, Doglietto G, Alfieri S, Piccioni E, Sgadari A, Gui D . Prognosis in intra-abdominal infections. Multivariate analysis on 604 patients. Arch Surg. 1996; 131(6):641-5. DOI: 10.1001/archsurg.1996.01430180067014. View

12.

Linder M, Wacha H, Feldmann U, Wesch G, Streifensand R, Gundlach E . [The Mannheim peritonitis index. An instrument for the intraoperative prognosis of peritonitis]. Chirurg. 1987; 58(2):84-92. View

13.

Wittmann D, SCHEIN M, Condon R . Management of secondary peritonitis. Ann Surg. 1996; 224(1):10-8. PMC: 1235241. DOI: 10.1097/00000658-199607000-00003. View

14.

Wittmann D . Operative and nonoperative therapy of intraabdominal infections. Infection. 1998; 26(5):335-41. DOI: 10.1007/BF02962267. View

15.

Marshall J, Maier R, Jimenez M, Dellinger E . Source control in the management of severe sepsis and septic shock: an evidence-based review. Crit Care Med. 2004; 32(11 Suppl):S513-26. DOI: 10.1097/01.ccm.0000143119.41916.5d. View

16.

GRUNAU G, Heemken R, Hau T . Predictors of outcome in patients with postoperative intra-abdominal infection. Eur J Surg. 1996; 162(8):619-25. View

17.

Kologlu M, Elker D, Altun H, Sayek I . Validation of MPI and PIA II in two different groups of patients with secondary peritonitis. Hepatogastroenterology. 2001; 48(37):147-51. View

18.

Biondo S, Ramos E, Fraccalvieri D, Kreisler E, Marti Rague J, Jaurrieta E . Comparative study of left colonic Peritonitis Severity Score and Mannheim Peritonitis Index. Br J Surg. 2006; 93(5):616-22. DOI: 10.1002/bjs.5326. View

19.

Chromik A, Meiser A, Holling J, Sulberg D, Daigeler A, Meurer K . Identification of patients at risk for development of tertiary peritonitis on a surgical intensive care unit. J Gastrointest Surg. 2009; 13(7):1358-67. DOI: 10.1007/s11605-009-0882-y. View

20.

Knaus W, Draper E, Wagner D, Zimmerman J . APACHE II: a severity of disease classification system. Crit Care Med. 1985; 13(10):818-29. View