Operative vs percutaneous drainage of intra-abdominal abscesses. Comparison of morbidity and mortality
J. Olak, N. V. Christou, L. A. Stein, G. Casola and J. L. Meakins
This retrospective case-controlled study compares the morbidity and
mortality of 27 percutaneously drained (PD) abscesses with 27 that were
surgically drained (SD). Patients were matched for age, sex, diagnosis, and
abscess etiology and location. There was no difference in severity of
illness (acute physiology score [APS] = 8.3 vs 10.2), comparable morbidity
(29.6% vs 40.7%), or mortality (11.0% vs 7.4%) between PD and SD groups.
Duration of drainage was significantly longer in the PD group; however,
this is explained in part by the 48% vs 18.5% difference in associated
fistulae. Failures of the SD group had a higher mean APS (15) than both
failures of the PD group (APS = 9.3) and successes of the SD group (APS =
8.6). All three PD group deaths and half of the SD group deaths were
related to ongoing sepsis. Surgical drainage of intra-abdominal abscess is
as successful as PD. Percutaneous drainage is reasonable initial treatment
for intra-abdominal abscess; however, early assessment of clinical status
and frequent reassessment are mandatory to ensure that failures are dealth
with early. We present a drainage algorithm.
