Acute prognosis of critically ill patients with secondary peritonitis: the impact of the number of surgical revisions, and of the duration of surgical therapy

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• 作者：Dominik Rü ; ttinger ; M.D.^a ; David Kuppinger ; M.D.^a ; Manuela Hö ; lzwimmer ; B.Sc.^b ; Sabrina Zander ; B.Sc.^b ; Markus Vilsmaier ; M.D.^a ; Helmut Kü ; chenhoff ; Ph.D.^b ; Karl-Walter Jauch ; M.D.^a ; Wolfgang H. Hartl ; M.D.^a ; ^{whartl@med.uni-muenchen.de}
• 关键词：Peritonitis ; Intensive care ; Acute survival ; Number of surgical revisions
• 刊名：The American Journal of Surgery
• 出版年：2012
• 期刊代码：9_00029610
• 类别：med
• 出版时间：July, 2012
• 卷：204
• 期：1
• 页码：28-36
• 文件大小：1104 K

摘要

Background

Duration of surgical therapy and the number of surgical revisions performed to control the focus may be important prognostic variables. Association of such time-dependent therapies with survival, however, has not yet been studied.

Methods

We analyzed survival times of adult patients (n = 283) who were suffering from secondary peritonitis and associated organ failure. Cox-type additive hazard regression models were used to analyze associations of surgical variables with survival time.

Results

Seventy-two patients (25.4%) survived the period of excess mortality after intensive care unit admission. A total of 79.5%of the 283 patients required one or more surgical revisions. Besides the underlying disease and disease severity at intensive care unit admission, there was a nonlinear smoothed association between a poorer outcome and the duration of surgical therapy, and the number of surgical revisions. For the latter, hazard ratios increased sharply between 1 and 5 revisions, and remained largely constant later on.

Conclusions

In critically ill patients with peritonitis, a long therapy and the necessity for a high number of reoperations is related inversely to acute survival.