The role of the intra-abdominal view in complicated intra-abdominal infections

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http://hdl.handle.net/10138/301133

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Tolonen , M , Sallinen , V , Leppäniemi , A , Bäcklund , M & Mentula , P 2019 , ' The role of the intra-abdominal view in complicated intra-abdominal infections ' , World journal of emergency surgery , vol. 14 , no. 1 , 15 . https://doi.org/10.1186/s13017-019-0232-7

Title: The role of the intra-abdominal view in complicated intra-abdominal infections
Author: Tolonen, Matti; Sallinen, Ville; Leppäniemi, Ari; Bäcklund, Minna; Mentula, Panu
Contributor: University of Helsinki, Clinicum
University of Helsinki, Pertti Panula / Principal Investigator
University of Helsinki, II kirurgian klinikka
University of Helsinki, Department of Diagnostics and Therapeutics
University of Helsinki, II kirurgian klinikka
Date: 2019-03-29
Language: eng
Number of pages: 10
Belongs to series: World journal of emergency surgery
ISSN: 1749-7922
URI: http://hdl.handle.net/10138/301133
Abstract: BackgroundThe prognostic role of what a surgeon observes in the abdomen of patients with complicated intra-abdominal infection (cIAI) is largely unknown. The aim of this prospective study was to systemically analyze components of the intra-abdominal view (IAV) and their association to severe complicated intra-abdominal sepsis (SCIAS) or mortality.MethodsThe study cohort consisted of adult patients with cIAI. The operating surgeon filled a paper form describing the intra-abdominal view. Demographics, operative details, and preoperative physiological status were collected. Descriptive, univariate, and multivariate statistical analyses were performed, and a new score was developed based on regression coefficients. The primary outcome was a composite outcome of SCIAS or 30-day mortality, in which SCIAS was defined as organ dysfunctions requiring intensive care unit admission.ResultsA total of 283 patients were analyzed. The primary outcome was encountered in 71 (25%) patients. In the IAV, independent risk factors for the primary outcome were fecal or bile as exudate (odds ratio (OR) 1.98, 95% confidence interval 1.05-3.73), diffuse peritonitis (OR 2.15, 1.02-4.55), diffuse substantial redness of the peritoneum (OR 5.73, 2.12-15.44), and a non-appendiceal source of cIAI (OR 11.20, 4.11-30.54). Based on these factors, an IAV score was developed and its performance analyzed. The area under the receiver operating characteristic for the IAV score was 0.81. The IAV score also correlated significantly with several outcomes and organ dysfunctions.ConclusionsThe extent of peritonitis, diffuse substantial redness of the peritoneum, type of exudate, and source of infection associate independently with SCIAS or mortality. A high IAV score associates with mortality and organ dysfunctions, yet it needs further external validation. Combining components of IAV into comprehensive scoring systems for cIAI patients may provide additional value compared to the current scoring systems.Trial registrationThe study protocol was retrospectively registered on April 4, 2016, right after the first enrolled patient at Clinicaltrials.gov database (NCT02726932).
Subject: CLASSIFICATION
DIVERTICULITIS
Emergency surgery
Intra-abdominal infection
Intra-abdominal view
LAPAROSCOPIC LAVAGE
PERITONITIS
SEPSIS
Secondary peritonitis
Sepsis
Severe peritonitis
3126 Surgery, anesthesiology, intensive care, radiology
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