Abstract | BACKGROUND: METHODS: Prospective study of 465 critically ill surgical patients with hollow viscus perforation and peritonitis or abscess from 1991-2002. Data collected were age, gender, admission APACHE III score, multiple organ dysfunction score, ICU and hospital length of stay, abscess (yes/no), site and type of perforation (colon vs. other), de novo vs. nosocomial origin, and mortality. Statistical analysis was by univariate ANOVA for coordinate data, Fisher exact test for continuous data, and logistic regression analysis. RESULTS: The incidence of intra-abdominal infection was 5.75%, 73.7% of the patients developed organ dysfunction, and mortality was 22.6%. Females comprised 46.8% of the patients. De novo infection represented 71.8% of cases, whereas nosocomial infection comprised 28.2% of cases. Perforations were of the colon (including the appendix) 49.9% of the time. An abscess formed in 22.3% of patients; the remainder had peritonitis but no abscess. Patients in the cohort with peritonitis were older (p = 0.0157), sicker on admission (p = 0.0411) and developed more organ dysfunction (p = 0.0072), but had the same rate of mortality. Despite steadily increasing acuity since 1991 (r(2) = .71, p < 0.0001), the magnitude of organ dysfunction (r(2) = 0.11) and the mortality rate remained constant (r(2) = .01). By logistic regression, abscess correlated with less severe organ dysfunction (score > or = 5 [odds ratio 0.54, 95% CI 0.33-0.90] and > or =9 points [odds ratio 0.38, 95% CI 0.20-0.74]), and increasing magnitude of organ dysfunction was associated with mortality (each point [odds ratio 1.46, 95% CI 1.32-1.61]). CONCLUSIONS:
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Authors | Philip S Barie, Lynn J Hydo, Soumitra R Eachempati |
Journal | Surgical infections
(Surg Infect (Larchmt))
Vol. 5
Issue 4
Pg. 365-73
( 2004)
ISSN: 1096-2964 [Print] United States |
PMID | 15744128
(Publication Type: Journal Article)
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Topics |
- Abdominal Abscess
(etiology, mortality, surgery)
- Aged
- Cohort Studies
- Critical Illness
- Drainage
- Female
- Humans
- Intensive Care Units
- Intestinal Perforation
(complications)
- Longitudinal Studies
- Male
- Middle Aged
- Multiple Organ Failure
(etiology, mortality, surgery)
- Outcome Assessment, Health Care
- Peritonitis
(etiology, mortality, surgery)
- Prospective Studies
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