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

Matti Tolonen, Ville Sallinen, Ari Leppäniemi, Minna Bäcklund, Panu Mentula, Matti Tolonen, Ville Sallinen, Ari Leppäniemi, Minna Bäcklund, Panu Mentula

Abstract

Background: The 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.

Methods: The 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.

Results: A 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.

Conclusions: The 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 registration: The study protocol was retrospectively registered on April 4, 2016, right after the first enrolled patient at Clinicaltrials.gov database (NCT02726932).

Keywords: Emergency surgery; Intra-abdominal infection; Intra-abdominal view; Secondary peritonitis; Sepsis; Severe peritonitis.

Conflict of interest statement

HUS Helsinki University Hospital operative ethics committee (Dnro 6/13/03/02/2016) and review board approved the study design. A written informed consent was obtained from all the patients included in the study.Not applicable.The authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Patient flow chart
Fig. 2
Fig. 2
Receiver operating characteristic (ROC) curve for the intra-abdominal view (IAV) score and comparisons to other scores. Abbreviations: WSES World Society of Emergency Surgery, APACHE Acute Physiology And Chronic Health Evaluation, MPI Mannheim Peritonitis index, CI confidence interval
Fig. 3
Fig. 3
The intra-abdominal view (IAV) score correlations with pre- and postoperative organ dysfunctions. Legend: IAV scores are presented as median (interquartile range), *Mann-Whitney U test

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