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1. Deferred primary anastomosis versus diversion in patients with severe secondary peritonitis managed with staged laparotomies.

Author

Ordóñez CA, Sánchez AI, Pineda JA, Badiel M, Mesa R, Cardona U, Arias R, Rosso F, Granados M, Gutiérrez-Martínez MI, Ochoa JB, Peitzman A, and Puyana JC

Subjects
Adolescent, Adult, Aged, Aged, 80 and over, Anastomosis, Surgical, Chi-Square Distribution, Clinical Protocols, Colombia epidemiology, Critical Illness, Female, Humans, Length of Stay statistics & numerical data, Male, Middle Aged, Peritonitis mortality, Postoperative Complications mortality, Respiration, Artificial, Retrospective Studies, Statistics, Nonparametric, Survival Rate, Treatment Outcome, Laparotomy methods, Peritonitis surgery
Abstract

Background: There is inconclusive data on whether critically ill individuals with severe secondary peritonitis requiring multiple staged laparotomies may became eligible candidates for deferred primary anastomoses (DPA). We sought to compare a protocol for DPA against a protocol for diversion in severely ill critical patients with intra-abdominal sepsis., Methods: A retrospective cohort study was performed examining 112 patients admitted through an ICU between 2002 and 2006, with diagnosis of secondary peritonitis and managed with staged laparotomies whom required small- or large-bowel segment resections. Patients were categorized and compared according to the surgical treatment necessitated to resolve the secondary peritonitis (DPA versus diversion). Outcome measures were days on mechanical ventilation, days required in ICU, days required in hospital, incidence of fistulas/leakages, acute respiratory distress syndrome (ARDS), and mortality., Results: There were 34 patients subjected to DPA and 78 to diversion. Fistulas/leakages developed in three patients (8.8%) with DPA and four patients (5.1%) with diversion (p = 0.359). ARDS was present in 6 patients (17.6%) with DPA and 24 patients (30.8%) with diversion (p = 0.149). There were 30 patients (88.2%) with DPA and 65 patients (83.3%) with diversion discharged alive (p = 0.51). There were not statistical significant differences between groups among survivors regarding hospital length of stay, ICU length of stay, and days on mechanical ventilation., Conclusions: We did not find significant differences in morbidity or mortality when we compared DPA versus diversion surgical treatment. It is feasible to perform a primary anastomosis in critically ill patients with severe secondary peritonitis managed with staged laparotomies.

Published
2010
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2. Complicated intra-abdominal infections worldwide : the definitive data of the CIAOW Study

Author

Sartelli, Massimo, Catena, Fausto, Ansaloni, Luca, Coccolini, Frederico, Corbella, Davide, Moore, Ernest, Malangoni, Mark, Velmahos, George, Coimbra, Raul, Koike, Kaoru, Leppaniemi, Ari, Biffl, Walter, Balogh, Zsolt, Bendinelli, Cino, Gupta, Sanjay, Kluger, Yoram, Agresta, Ferdinando, Di Saverio, Salmone, Tugnoli, Gregorio, Jovine, Elio, Ordonez, Carlos, Whelan, James, Fraga, Gustavo, Carlos, Gomes, Augusto, Pereira, Gerson, Yuan, Kuo-Ching, Bala, Miklosh, Peev, Miroslav, Ben-Ishay, Offir, Cui, Yunfeng, Marwah, Sanjay, Zachariah, Sanoop, Wani Imtiaz, Rangarajan, Muthukumaran, Sakakushev, Boris, Kong, Victor, Ahmed, Adamu, Abbas, Ashraf, Gonsaga, Ricardo, Guercioni, Gianluca, Vettoretto, Nereo, Poiasina, Elia, Díaz-Nieto, Rafael, Massalou, Damien, Skrovina, Matej, Gerych, Ihor, Augustin, Goran, Kenig, Jakub, Khokha, Vladimir, Tranà, Cristian, Kok, Kenneth, Mefire, Alain, Lee, Jae, Hong, Suk-Kyung, Lohse, Helmut, Ghnnam, Wagih, Verni, Alfredo, Lohsiriwat, Varut, Siribumrungwong, Boonying, El Zalabany, Tamer, Tavares, Alberto, Baiocchi, Gianluca, Das, Koray, Jarry, Julien, Zida, Maurice, Sato, Norio, Murata, Kiyoshi, Shoko, Tomohisa, Irahara, Takayuki, Hamedelneel, Ahmed, Naidoo, Noel, Adesunkanmi, Abdul, Kobe, Yoshiro, Ishii, Wataru, Oka, Kazuyuki, Izawa, Yoshimitsu, Hamid, Hytham, Khan, Iqbal, Attri, AK, Sharma, Rajeev, Sanjuan, Juan, Badiel, Marisol, Barnabé, Rita, II kirurgian klinikka, [Sartelli, M] Department of Surgery, Macerata Hospital, Macerata, Italy. [Catena, F] Emergency Surgery, Maggiore Parma Hospital, Parma, Italy. [Ansaloni, L, Coccolini, F, Poiasina, E] Department of General Surgery, Ospedali Riuniti, Bergamo, Italy. [Corbella, D] Department of Anestesiology, Ospedali Riuniti, Bergamo, Italy. [Moore, EE, Biffl, W] Department of Surgery, Denver Health Medical Center, Denver, USA. [Malangoni, M] American Board of Surgery, Philadelphia, USA. [Velmahos, G, Peev, MP] Division of Trauma, Emergency Surgery and Surgical Critical Care, Harvard Medical School, Massachusetts General Hospital, Massachusetts, USA. [Coimbra, R] Department of Surgery, UC San Diego Health System, San Diego, USA. [Koike, K] Department of Primary Care & Emergency Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan. [Leppaniemi, A] Department of Abdominal Surgery, University Hospital Meilahti, Helsinki, Finland. [Balogh, Z, Bendinelli, C] Department of Surgery, University of Newcastle, Newcastle, NSW, Australia. [Gupta, S] Department of Surgery, Govt Medical College and Hospital, Chandigarh, India. [Kluger, Y, Ben-Ishay, O, Attri, A, Sharma, R] Department of General Surgery, Rambam Health Care Campus, Haifa, Israel. [Agresta, F] Department of Surgery, Adria Hospital Adria, Adria, Italy. [Di Saverio, S, Tugnoli, G] Trauma Surgery Unit, Maggiore Hospital, Bologna, Italy. [Jovine, E, Bananbé, R] Department of Surgery, Maggiore Hospital, Bologna, Italy. [Ordoñez, CA, Sanjuán, J, Badiel, M] Department of Surgery, Fundación Valle del Lilí, Cali, Colombia. [Whelan, JF] Division of Trauma/Critical Care Department of Surgery Virginia Commonwealth University, Richmond, VA, USA. [Fraga, GP] Division of Trauma Surgery, Campinas University, Campinas, Brazil. [Gomes, CA] Department of Surgery, Monte Sinai Hospital, Juiz de Fora, Brazil. [Pereira, CA] Department of Surgery, Emergency Unit, Ribeirão Preto, Brazil. [Yuan, KC]Department of Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan. [Bala, M] Department of General Surgery, Hadassah Medical Center, Jerusalem, Israel. [Cui, Y] Department of Surgery, Tianjin Nankai Hospital, Nankai Clinical School of Medicine, Tianjin Medical University, Tianjin, China. [Marwah, S] Department of Surgery, Pt BDS Post-graduate Institute of Medical Sciences, Rohtak, India. [Zachariah, S] Department of Surgery, MOSC Medical College, Cochin, India. [Wani, I] Department of Surgery, SKIMS, Srinagar, India. [Rangarajan, M] Department of Surgery, Kovai Medical Center, Coimbatore, India. [Shakakusev, B] First Clinic of General Surgery, University Hospital/UMBAL/St George Plovdiv, Plovdiv, Bulgaria. [Kong, V] Department of Surgery, Edendale Surgery, Pietermaritzburg, Republic of South Africa. [Ahmed, A] Department of Surgery, Ahmadu Bello University Teaching Hospital Zaria, Kaduna, Nigeria. [Abbas, A, Ghnnam, W] Department of Surgery, Mansoura University Hospital, Mansoura, Egypt. [Gonsaga, RA] Department of Surgery, Faculdades Integradas Padre Albino, Catanduva, Brazil. [Guercioni, G] Department of Surgery, Mazzoni Hospital, Ascoli Piceno, Italy. [Vettoretto, N] Department of Surgery, Mellini Hospital, Chiari, BS, Italy. [Díaz-Nieto, R] Department of General and Digestive Surgery, Virgen de la Victoria, University Hospital, Málaga, Spain. [Massalou, D] Department of General Surgery and Surgical Oncology, Université de Nice Sophia-Antipolis, Universitary Hospital of Nice, Nice, France. [Skrovina, M] Department of Surgery, Hospital and Oncological Centre, Novy Jicin, Czech Republic. [Gerych, I] Department of General Surgery, Lviv Emergency Hospital, Lviv, Ukraine. [Augustin, G] Department of Surgery, University Hospital Center Zagreb, Zagreb, Croatia. [Kenig, J] 3rd Department of General Surger Jagiellonian Univeristy, Narutowicz Hospital, Krakow, Poland. [Khokha, V] Department of Surgery, Mozyr City Hospital, Mozyr, Belarus. [Tranà, C] Department of Surgery, Ancona University, Ancona, Italy. [Kok, KY] Department of Surgery, Ripas Hospital, Bandar Seri Begawan, Brunei. [Mefire, AC] Clinical Sciences, Regional Hospitals Limbe and Buea, Limbe, Cameroon. [Lee, JG] Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea. [Hong, SK] Division of Trauma and Surgical Critical Care, Department of Surgery, University of Ulsan, Seoul, Republic of Korea. [Lohse, HA] II Cátedra de Clínica Quirúrgica, Hospital de Clínicas, Asuncion, Paraguay. [Verni, A] Department of Surgery, Cutral Có Clinic, Cutral Có, Argentina. [Lohsiriwat, V] Department of Surgery, Faculty of Medicine Siriraj Hospital, Bangkok, Thailand. [Siribumrungwong, B] Department of Surgery, Thammasat University Hospital, Pathumthani, Thailand. [El Zalabany, T] Department of Surgery, Bahrain Defence Force Hospital, Manama, Bahrain. [Tavares, A] Department of Surgery, Hospital Regional de Alta Especialidad del Bajio, Leon, Mexico. [Baiocchi, G] Clinical and Experimental Sciences, Brescia Ospedali Civili, Brescia, Italy. [Das, K] General Surgery, Adana Numune Training and Research Hospital, Adana, Turkey. [Jarry, J] Visceral Surgery, Military Hospital Desgenettes, Lyon, France. [Zida, M] Visceral Surgery, Teaching Hospital Yalgado Ouedraogo, Ouedraogo, Burkina Faso. [Murata, K] Department of Acute and Critical care medicine, Tokyo Medical and Dental University, Tokyo, Japan. [Shoko, T] he Shock Trauma and Emergency Medical Center, Matsudo City Hospital, Chiba, Japan. [Irahara, T] Emergency and Critical Care Center of Nippon Medical School, Tama-Nagayama Hospital, Tokyo, Japan. [Hamedelneel, AO] Department of Surgery, Our Lady of Lourdes Hospital, Drogheda, Ireland. [Naidoo, N] Department of Surgery, Port Shepstone Hospital, Port Shepstone, South Africa. [Adesunkanmi, AR] Department of Surgery, Obafemi Awolowo UNiversity Hospital, Ile-Ife, Nigeria. [Kobe, Y] Department of Emergency and Critical Care Medicine, Chiba University Hospital, Chiba, Japan. [Ishii, W] Department of Emergency and Critical Care Medicine, Chiba University Hospital, Chiba, Japan, and Depatment of Emergency Medicine, Kyoto Second Red Cross Hospital, Kyoto, Japan. [Oka, K] Tajima emergency & Critical Care Medical Center, Toyooka Public Hospital, Toyooka, Hyogo, Japan. [Izawa, Y] Emergency and Critical Care Medicine, Jichi Medical University, Shimotsuke, Japan. [Hamid, H] Department of Surgery, Mayo General Hospital Castlebar Co. Mayo, Castlebar, Ireland.

Subjects
Analytical, Diagnostic and Therapeutic Techniques and Equipment::Surgical Procedures, Operative::Digestive System Surgical Procedures [Medical Subject Headings], APPENDICEAL ABSCESS, medicine.medical_treatment, Diseases::Bacterial Infections and Mycoses::Infection::Cross Infection [Medical Subject Headings], Phenomena and Processes::Microbiological Phenomena::Drug Resistance, Microbial [Medical Subject Headings], Analytical, Diagnostic and Therapeutic Techniques and Equipment::Therapeutics::Drainage [Medical Subject Headings], Organisms::Eukaryota::Animals::Chordata::Vertebrates::Mammals::Primates::Haplorhini::Catarrhini::Hominidae::Humans [Medical Subject Headings], Analytical, Diagnostic and Therapeutic Techniques and Equipment::Surgical Procedures, Operative::Reoperation [Medical Subject Headings], Study Protocol, Infección hospitalaria, Procedimientos quirúrgicos del sistema digestivo, Diseases::Bacterial Infections and Mycoses::Infection::Sepsis [Medical Subject Headings], Publication Characteristics::Study Characteristics::Multicenter Study [Medical Subject Headings], Enfermedad crítica, Adulto, Mortality rate, Farmacoresistencia microbiana, Immunosuppression, Diverticulitis, Humanos, 3. Good health, Emergency Medicine, Diseases::Digestive System Diseases::Peritoneal Diseases::Peritonitis [Medical Subject Headings], KLEBSIELLA-PNEUMONIAE, Reoperación, Diseases::Pathological Conditions, Signs and Symptoms::Pathologic Processes::Disease Attributes::Critical Illness [Medical Subject Headings], medicine.medical_specialty, CHOLECYSTECTOMY, education, Peritonitis, RELAPAROTOMY, Diseases::Bacterial Infections and Mycoses::Infection::Suppuration::Abscess::Abdominal Abscess [Medical Subject Headings], SECONDARY PERITONITIS, Internal medicine, complicated intra-abdomina infections, appendicitis, cholecystitis, postoperative, colonic perforation, gastroduodenal perforation, diverticulitis, small bowel perforation, Named Groups::Persons::Age Groups::Adult [Medical Subject Headings], medicine, MANAGEMENT, METAANALYSIS, Estudio multicéntrico, Diseases::Bacterial Infections and Mycoses::Infection::Intraabdominal Infections [Medical Subject Headings], SEPSIS, business.industry, Abdominal Infection, Absceso abdominal, ACUTE CHOLECYSTITIS, medicine.disease, 3126 Surgery, anesthesiology, intensive care, radiology, Infecciones intraabdominales, Appendicitis, Surgery, Cholecystitis, Drenaje, Cholecystectomy, business, DIVERTICULITIS
Abstract

Journal Article; The CIAOW study (Complicated intra-abdominal infections worldwide observational study) is a multicenter observational study underwent in 68 medical institutions worldwide during a six-month study period (October 2012-March 2013). The study included patients older than 18 years undergoing surgery or interventional drainage to address complicated intra-abdominal infections (IAIs). 1898 patients with a mean age of 51.6 years (range 18-99) were enrolled in the study. 777 patients (41%) were women and 1,121 (59%) were men. Among these patients, 1,645 (86.7%) were affected by community-acquired IAIs while the remaining 253 (13.3%) suffered from healthcare-associated infections. Intraperitoneal specimens were collected from 1,190 (62.7%) of the enrolled patients. 827 patients (43.6%) were affected by generalized peritonitis while 1071 (56.4%) suffered from localized peritonitis or abscesses. The overall mortality rate was 10.5% (199/1898). According to stepwise multivariate analysis (PR = 0.005 and PE = 0.001), several criteria were found to be independent variables predictive of mortality, including patient age (OR = 1.1; 95%CI = 1.0-1.1; p

Published
2014

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