Postoperative intra-abdominal sepsis requiring reoperation. Value of a predictive index.
In this study we analyze the results of the use of a predictive index to decide whether to perform abdominal reoperation in the event of septic complications. During a 5-year period, a population of 542 critically ill patients received major abdominal surgery. Patients were divided into two groups: (1) the control group, for which the decision to reoperate was made routinely, based on clinical consensus of the medical team; and (2) the Abdominal Reoperation Predictive Index group, for which the decision to reoperate was made with the help of a mathematical index involving eight mainly clinical variables. The use of Abdominal Reoperation Predictive Index enabled mortality among patients undergoing reoperation to be lowered, the time elapsing between the first operation and relaparotomy to be reduced, and the length of stay in the intensive care unit to be shortened. We conclude that the systematic application of an index, without disregarding clinical judgment, allows the quality of attention to be improved, cost to be lowered, and the level of conflicts generated by the difficult decision to perform reoperation to be curtailed.
Pusajó
J F
JF
General Surgery Service, Hospital Israelita Ezrah, Buenos Aires, Argentina.
Bumaschny
E
E
Doglio
G R
GR
Cherjovsky
M R
MR
Lipinszki
A I
AI
Hernández
M S
MS
Egurrola
M A
MA
D000005:Abdomen / Q000601:surgery*; D001118:Argentina / Q000453:epidemiology; D016638:Critical Illness; D003657:Decision Making; D005260:Female; D005544:Forecasting; D006801:Humans; D015994:Incidence; D007813:Laparotomy / Q000401:mortality; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000209:etiology; D012086:Reoperation; D012720:Severity of Illness Index; D013530:Surgical Wound Infection / Q000401:mortality / Q000601:surgery*; D015996:Survival Rate; D013997:Time Factors