Key result
A standardized two-stage damage-control surgery algorithm for severe intra-abdominal sepsis resulted in a 26% in-hospital mortality rate and allowed 65% of discharged patients to remain stoma-free.
Why the study?
Severe intra-abdominal sepsis is associated with high mortality and stoma rates, and while a two-stage damage-control approach might decrease these rates, it requires standardization.
Does a standardized two-stage damage-control surgery algorithm improve survival and stoma-free discharge rates in patients with severe intra-abdominal sepsis?
Cohort (n=203)
No
Does a standardized two-stage damage-control surgery algorithm improve survival and stoma-free discharge rates in patients with severe intra-abdominal sepsis?
A standardized two-stage damage-control surgery approach for severe intra-abdominal sepsis is feasible and allows for a high rate of stoma-free discharge (65%) with an acceptable in-hospital mortality rate (26%).
May support standardized two-stage damage-control surgery in severe intra-abdominal sepsis; hypothesis-generating and requires prospective trials before practice change.
BACKGROUND: Severe intra-abdominal sepsis (IAS) is associated with high mortality and stoma rates. A two-stage approach with initial damage-control surgery (DCS) and subsequent reconstruction might decrease stoma and mortality rates but requires standardization. METHODS: A standardized two-stage damage-control algorithm for IAS was implemented in April 2016 and applied systematically. RESULTS: Some 203 consecutive patients (median age 70 years, 62 per cent ASA score greater than 3) had DCS for severe IAS. Median operation time was 82 minutes, 60 per cent performed during night-time. Median intraoperative noradrenaline doses were 20 (i.q.r. 26) µg/min and blood gas analysis (ABG) was abnormal (metabolic acidosis) in 90 per cent of patients. The second-stage operation allowed definitive surgery in 76 per cent of patients, 24 per cent had up to four re-DCSs until definitive surgery. The in-hospital mortality rate was 26 per cent. At hospital discharge, 65 per cent of patients were stoma free. Risk factors for in-hospital death were noradrenaline (odds ratio 4.25 (95 per cent c.i. 1.72 to 12.83)), abnormal ABG (pH: odds ratio 2.72 (1.24 to 6.65); lactate: odds ratio 6.77 (3.20 to 15.78)), male gender (odds ratio 2.40 (1.24 to 4.85)), ASA score greater than 3 (odds ratio 5.75 (2.58 to 14.68)), mesenteric ischaemia (odds ratio 3.27 (1.71 to 6.46)) and type of resection (odds ratio 2.95 (1.24 to 8.21)). Risk factors for stoma at discharge were ASA score greater than 3 (odds ratio 2.76 (95 per cent c.i. 1.38 to 5.73)), type of resection (odds ratio 30.91 (6.29 to 559.3)) and longer operation time (odds ratio 2.441 (1.22 to 5.06)). CONCLUSION: Initial DCS followed by secondary reconstruction of bowel continuity for IAS within 48 hours in a tertiary teaching hospital was feasible and safe, following a clear algorithm.
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Faes et al. (2021) conducted a cohort in Severe intra-abdominal sepsis (n=203). Two-stage damage-control surgery was evaluated on Stoma-free at hospital discharge. A standardized two-stage damage-control surgery algorithm for severe intra-abdominal sepsis resulted in a 26% in-hospital mortality rate and allowed 65% of discharged patients to remain stoma-free.
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