Improved treatment of intra-abdominal abscess. A result of improved localization, drainage, and patient care, not technique
C. W. Deveney, K. Lurie and K. E. Deveney
Department of Surgery, Oregon Health Sciences University, Portland.
Outcome in patients with abdominal abscesses treated at the University of
Pennsylvania, Philadelphia, between 1973 and 1978 (group 1) was compared
with that in patients treated between 1981 and 1986 (group 2). Mortality
was less in group 2 patients (21% vs 39% in group 1). The decrease in
mortality in group 2 was accompanied by a greater percentage of successful
predrainage localization (74% vs 55% in group 1), successful initial
drainage (76% vs 55% in group 1), and decreased predrainage organ failure
(23% vs 52% in group 1). Because failure of initial drainage and
predrainage organ failure were associated with increased mortality,
improvement in both of these criteria contributed substantially to the
lower mortality in group 2 patients. There were no differences in
mortality, in initial success in drainage, or in length of hospital stay
when 29 group 2 patients who underwent percutaneous drainage were compared
with 37 patients who underwent surgical drainage. Mortality (22% vs 21%)
and initial success (78% vs 72%) were similar for patients who underwent
surgical and percutaneous drainage, respectively. We conclude that initial
success in localization and drainage of the abscess is more important than
whether drainage is surgical or percutaneous.