title: Time from admission to initiation of surgery for source control is a critical determinant of survival in patients with gastrointestinal perforation with associated septic shock.
abstract: BACKGROUND
  We developed a protocol to initiate surgical source control immediately after admission (early source control) and perform initial resuscitation using early goal-directed therapy (EGDT) for gastrointestinal (GI) perforation with associated septic shock. This study evaluated the relationship between the time from admission to initiation of surgery and the outcome of the protocol.
  
  
  METHODS
  This examination is a prospective observational study and involved 154 patients of GI perforation with associated septic shock. We statistically analyzed the relationship between time to initiation of surgery and 60-day outcome, examined the change in 60-day outcome associated with each 2 hour delay in surgery initiation and determined a target time for 60-day survival.
  
  
  RESULTS
  Logistic regression analysis demonstrated that time to initiation of surgery (hours) was significantly associated with 60-day outcome (Odds ratio (OR), 0.31; 95% Confidence intervals (CI)), 0.19-0.45; P <0.0001). Time to initiation of surgery (hours) was selected as an independent factor for 60-day outcome in multiple logistic regression analysis (OR), 0.29; 95% CI, 0.16-0.47; P <0.0001). The survival rate fell as surgery initiation was delayed and was 0% for times greater than 6 hours.
  
  
  CONCLUSIONS
  For patients of GI perforation with associated septic shock, time from admission to initiation of surgery for source control is a critical determinant, under the condition of being supported by hemodynamic stabilization. The target time for a favorable outcome may be within 6 hours from admission. We should not delay in initiating EGDT-assisted surgery if patients are complicated with septic shock.
authors.forename: Takeo
authors.initials: T
authors.lastname: Azuhata
authors.forename: Kosaku
authors.initials: K
authors.lastname: Kinoshita
authors.forename: Daisuke
authors.initials: D
authors.lastname: Kawano
authors.forename: Tomonori
authors.initials: T
authors.lastname: Komatsu
authors.forename: Atsushi
authors.initials: A
authors.lastname: Sakurai
authors.forename: Yasutaka
authors.initials: Y
authors.lastname: Chiba
authors.forename: Katsuhisa
authors.initials: K
authors.lastname: Tanjho
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D041981:Gastrointestinal Tract / Q000293:injuries / Q000601:surgery; D006801:Humans; D007416:Intestinal Perforation / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000592:standards*; D011446:Prospective Studies; D012772:Shock, Septic / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D015996:Survival Rate / Q000639:trends; D061665:Time-to-Treatment / Q000592:standards*