Predictors of outcome in patients with postoperative intra-abdominal infection.

OBJECTIVE

To assess those factors which predict prognosis in patients with postoperative intra-abdominal infections.

DESIGN

Open study.

SETTING

Teaching hospital, Germany.

SUBJECTS

48 patients who developed postoperative intra-abdominal infections between January 1989 and July 1993.

INTERVENTIONS

Calculation of APACHE II score and Mannheim Peritonitis Index (MPI). Evaluation of single components of APACHE II score.

MAIN OUTCOME MEASURE

Correlation between outcome and these variables together with time between first operation and reexploration, whether the source of infection was eliminated, whether the abdomen was managed by a closed or open technique, and the extent and origin of the infection.

RESULTS

Both APACHE II and MPI predicted outcome. Of the single components of the APACHE II score studied, those that correlated significantly with outcome were the Glasgow coma scale and chronic health evaluation (p < 0.001 in each case), and age (p < 0.01). The extent of peritonitis (local or diffuse) correlated with the APACHE II score and with outcome (p < 0.001 in each case). The time that elapsed before reoperation was significantly shorter in patients who died (8 days) than in those who survived (16 days, p = 0.03). In 37 of the patients the source of infection was eliminated resulting in 7 deaths (19%); all 11 of those in whom it was not eliminated died. Of the 35 patients who underwent closed treatment of the abdominal cavity 8 died (23%) compared with 10 of the 13 who underwent etappenlavage (77%, p < 0.01). Patients who underwent closed treatment, however, had fewer risk factors. No other variable correlated with outcome.

CONCLUSIONS

Outcome of patients with postoperative intra-abdominal infections correlates significantly with APACHE II and MPI, and in particular with age, Glasgow coma scale, and chronic health evaluation. It also correlates with time between the first and subsequent operations. Elimination of the source of infection and closed treatment of the abdominal cavity are associated with less risk factors and increased survival.