title: Differences in morbidity and mortality with percutaneous versus open surgical drainage of postoperative intra-abdominal infections: a review of 686 cases.
abstract: Intra-abdominal infections following surgical procedures result from organ-space surgical site infections, visceral perforations, or anastomotic leaks. We hypothesized that open surgical drainage is associated with increased patient morbidity and mortality compared with percutaneous  drainage. A single-institution, prospectively collected database over a 13-year period revealed 2776 intra-abdominal infections, 686 of which required an intervention after the index operation. Percutaneous procedures (simple aspiration or catheter placement) were compared with all other open  procedures by univariate and multivariate analyses. Analysis revealed 327 infections in 240 patients undergoing open surgical drainage and 359 infections in 260 patients receiving percutaneous drainage. Those undergoing open drainage had significantly higher Acute Physiology Score (APS) and  Acute Physiology and Chronic Health Evaluation (APACHE) II scores and were more likely to be immunosuppressed, require intensive care unit treatment, and have longer hospital stays. Mortality was higher in the open group: 14.6 versus 4.2 per cent (P = 0.0001). Variables independently  associated with death by multivariate analysis were APACHE II, dialysis, intensive care unit (ICU) care, age, immunosuppression, and drainage method. Open intervention for postsurgical intra-abdominal infections is associated with increased mortality compared with percutaneous drainage even  after controlling for severity of illness by multivariate analysis. Although some patients are not candidates for percutaneous drainage, it should be considered the preferential treatment in eligible patients.
authors.affiliation: Department of Surgery, University of Virginia Health System, Charlottesville, Virginia, USA. adp2q@virginia.edu
authors.forename: Amani D
authors.initials: AD
authors.lastname: Politano
authors.forename: Tjasa
authors.initials: T
authors.lastname: Hranjec
authors.forename: Laura H
authors.initials: LH
authors.lastname: Rosenberger
authors.forename: Robert G
authors.initials: RG
authors.lastname: Sawyer
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Tache Leon
mesh_terms: D000005:Abdomen / Q000601:surgery*; D004322:Drainage / Q000009:adverse effects* / Q000379:methods*; D005260:Female; D006801:Humans; D007239:Infections / Q000209:etiology* / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology* / Q000401:mortality; D011446:Prospective Studies