Surgical treatment of patients with abdominal sepsis taking into account the prediction of the implementation of re-operations

Keywords: аbdominal sepsis, stratification of risk, estimation of severity, investigations, surgery.

Abstract

Objective. The investigation objective was improvement of the surgical treatment results in patients, suffering аbdominal sepsis, using individualized tactics of treatment, taking into account a possibility for the postoperative complications occurrence and the treatment results prognostication.

Маterials and methods. The results of treatment of the adult patients, suffering abdominal sepsis in 2009 – 2019 yrs, excluding an acute cholecystitis cases, were analyzed. The patients were divided retrospectively and prospectively in accordance to the Sepsis–3 classification. Of them 130 have suffered peritoneal sepsis, 33 – intestinal one, and 38 – pancreatogenic abdominal. The results estimation was compared with application of modern systems: APACHE–II, Mannheim іndex of peritonitis (MPI), MODS and SOFA. The indices were estimated on the 1st, 2nd, 3rd and 4th postoperative days before subsequent outcomes of a primary operation.

Results. The prognosis systems with a square under the ROC–curve (AUC) > 0.8 have included MPI only for determination of indications for reoperations: the ROC–curves value for the first subgroup (the closed treatment) have constituted 0.73, for the second subgroup (reoperations in accordance to indications) – 0.91, and for the third – 0.84 (the programmed reoperations). But in the patients of first subgroup this index have constituted 0,73, indicating its application restricting the decision making process, concerning the reoperations efficacy in patients with absence of the septic shock signs.

Conclusion. Calculations of the occurrence possibility for postoperative complications and mortality in patients, depending on their preoperative state severity permits to select a most rational tactics of treatment. Most optimal approach for the rate reduction of postoperative complications occurrence and mortality in patients with abdominal sepsis and septic shock is performance of reoperations in accordance to indications to control the infection source, if it is possible.

Author Biographies

I. A. Kryvoruchko, Kharkiv National Medical University

Kryvoruchko Igor Andriiovych – MD, DSci(Med), Professor,
Head of the Surgery Department No. 2,
Kharkiv National Medical University,
E-mail: ikryvoruchko60@gmail.com
https://orcid.org/0000-0002-5525-701Х

M. S. Antonova, Kharkiv National Medical University

Antonova Marina Sergiyovna – MD, PhD(Med),
assistant of the Department of Surgery No. 2,
Kharkiv National Medical University; Kharkiv, Ukraine.
https://orcid.org/0000-0002-5731-6183.

O. V. Yevtushenko, Kharkiv National Medical University

Ievtushenko Oleksandr Vasyliovych – MD, Graduate student
Surgery Department No. 2,
Kharkiv National Medical University; Kharkiv, Ukraine.
E-mail: jacomo@ukr.net
https://orcid.org/0000-0002-6957-4404.

S. A. Andreieshchev, Shupyk National Medical Academy of Postgraduate Education, Kyiv

Andreieshchev Sergey A., MD, PhD, associate professor,
associate professor Department of Surgery and Transplantology,
Shupyk National Medical Academy of Postgraduate Education.
30 Heroiv Sevastopolia Str., 03680, Kyiv, Ukraina,
+38 (044) 4081811
info@hirurgiya.com.ua
http://orcid.org/0000-0002-2281-1803

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Published
2020-05-26
How to Cite
Kryvoruchko, I. A., Antonova, M. S., Yevtushenko, O. V., & Andreieshchev, S. A. (2020). Surgical treatment of patients with abdominal sepsis taking into account the prediction of the implementation of re-operations. Klinicheskaia Khirurgiia, 87(1-2), 24-29. https://doi.org/10.26779/2522-1396.2020.1-2.24
Section
General Problems of Surgery

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