Postoperative intra-abdominal sepsis requiring reoperation. Value of a predictive index
J. F. Pusajo, E. Bumaschny, G. R. Doglio, M. R. Cherjovsky, A. I. Lipinszki, M. S. Hernandez and M. A. Egurrola
General Surgery Service, Hospital Israelita Ezrah, Buenos Aires, Argentina.
In this study we analyze the results of the use of a predictive index to
decide whether to perform abdominal reoperation in the event of septic
complications. During a 5-year period, a population of 542 critically ill
patients received major abdominal surgery. Patients were divided into two
groups: (1) the control group, for which the decision to reoperate was made
routinely, based on clinical consensus of the medical team; and (2) the
Abdominal Reoperation Predictive Index group, for which the decision to
reoperate was made with the help of a mathematical index involving eight
mainly clinical variables. The use of Abdominal Reoperation Predictive
Index enabled mortality among patients undergoing reoperation to be
lowered, the time elapsing between the first operation and relaparotomy to
be reduced, and the length of stay in the intensive care unit to be
shortened. We conclude that the systematic application of an index, without
disregarding clinical judgment, allows the quality of attention to be
improved, cost to be lowered, and the level of conflicts generated by the
difficult decision to perform reoperation to be curtailed.
