A. Siletz1, H. Cryer1, A. Cheaito1 1University Of California – Los Angeles,General Surgery,Los Angeles, CA, USA
Background: Despite advances in critical care medicine and surgical interventions the prognosis of peritonitis and intraabdominal sepsis remains poor. Many scoring systems have evolved to evaluate patients for surgical or medical interventions; However, none have looked at the time it takes to initiate the intervention; The purpose of this study is assess if time for aggressive intervention impacts outcome for this patient population.
Method: Retrospective chart review was performed for patients that required surgical intervention for intra-abdominal sepsis during a two year period. Demographic data including sex, age, and presenting disease was collected. Time of antibiotics administration was also noted; APACHE scores were extrapolated on these patients. Time the disease started (Ts), time the diagnosis was made (Td), and time of surgical intervention (Ti) were recorded based on careful chart review. Outcome measures included mortality, multi organ failure, ICU stay, and hospital stay.
Results: One hundred thirty eight patients were operated on for intra-abdominal sepsis from 2011-2013. Overall mortality for patients who required intervention was 32%; ICU stay and total hospital stay were 9±2 days and 21 ±3 days respectively. Accounting for APACHE score mortality was different among patients with Ti-Td > or <150 minutes (48.7% vs. 22%); ICU stay also differed among the same group (14 vs. 6 days). Ti-Ts > 2 days was also associated with longer hospital stay. Multivariate analysis showed that APACHE score (p<0.01), administration of antibiotic (p<0.01), and Ti-Td <150 minutes (p<0.01) independtly predicted survival and ICU stay.
Conclusion: Intra-abdominal sepsis is a time related and dynamic process. As times passes patient physiology, and ultimately prognosis changes. Among patients with intra-abdominal source time from diagnosis to time of intervention is critical for survival and outcome. Time of administering antibiotics is also important in predicting outcome. Better triaging of patients requiring surgical intervention is needed.