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Abdominal sepsis in patients 65-onwards after non-scheduled laparotomy

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Introduction

Abdominal sepsis after emergency laparotomy has a high mortality rate because is associated with a great number of serious complications. The aim of this study was to assess abdominal sepsis associated mortality and to determine which variables could predict the possibility that abdominal sepsis occur.

Materials and methods

We prospectively studied 128 patients, 65 onwards, who underwent emergency laparotomy (abdominal resection, perforation or ischaemia). In every patient we recorded several variables of the pre, intra and postoperative period. By patient's history, radiographic and scan studies, laboratory tests specific for the type of surgery performed, wound inspection and surgical reexploration, we determine the presence of abdominal infection. We also studied mortality associated with this type of infection and variables that could predict its appearing (multiple logistic regression analysis, using a model in which probability an event P will occur is 1/(1+ez), where z is the linear combination, z=B0+B1X1+ B2X2+ .....BPXP; B0, B1, B2,...Bp are coefficients estimated from the data, × is the independent variable and e is the base of the natural logarithms, approximately 2.718). Statistical analysis was made with SPSS for Windows 5.01® (multiple logistic regression analysis and Fisher exact test as required) and P<0.05 was regarded as significant.

Results

We evaluated 52 women and 76 men and patients' characteristics were (mean ± standard deviation): age 75.27± 7.52 and weight 70.34± 16.35. Abdominal sepsis was recorded in 15 patients (11.7%) and 10 died (66.67%). Mortality associated with abdominal infection was greater than mortality in patients without abdominal sepsis. Indeed, variables that can predict abdominal sepsis were diffuse vascular peripheral disease, acute renal failure, ARDS, surgical reexploration and a hospital stay greater than 7 days.

Conclusions

Emergency laparotomy has a greater mortality in patients with abdominal sepsis (66.67 vs 27%). Variables that can predict its appearing are: decreasing O2 tissue delivery factors, events that increase the possibility of nosocomial infection or those circumstances favouring multisystemic organ failure (lung or kidney).

References

  1. 1.

    Cook TM, Day CJE: Hospital mortality after urgent and emergency laparotomy in patients aged 65 years and over: Risk and prediction of risk using multiple logistic regression analysis. Br J Anaesth 1998, 80: 776.

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García-Saura, P., Peramo, F., Serrano, C. et al. Abdominal sepsis in patients 65-onwards after non-scheduled laparotomy. Crit Care 4, P217 (2000). https://doi.org/10.1186/cc936

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Keywords

  • Acute Renal Failure
  • Organ Failure
  • Nosocomial Infection
  • Fisher Exact Test
  • Vascular Peripheral Disease