Predictors of Outcome Following Surgery in Colonic Perforation: An Institution’s Experience Over 6 Years

Tan, Ker‐Kan; Hong, Choon Chiet; Zhang, Junren; Liu, Jody Zhiyang; Sim, Richard

doi:10.1007/s11605-010-1330-8

Cited by 31 publications

(24 citation statements)

References 38 publications

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“…Torer et al and Tan et al identified possible prognostic relevance for the MPI in retrospective cohorts with patients with secondary peritonitis due to postoperative complications and community acquired perforations of small bowel and colon [17-20]. However, quantification of or changes in organ failure does not seem to differentiate between ongoing organ failure due to abdominal sepsis despite source control of the initial causative focus and ongoing abdominal infection.…”

Section: Discussionmentioning

confidence: 99%

Failure of available scoring systems to predict ongoing infection in patients with abdominal sepsis after their initial emergency laparotomy

et al. 2011

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BackgroundTo examine commonly used scoring systems, designed to predict overall outcome in critically ill patients, for their ability to select patients with an abdominal sepsis that have ongoing infection needing relaparotomy.MethodsData from a RCT comparing two surgical strategies was used. The study population consisted of 221 patients at risk for ongoing abdominal infection. The following scoring systems were evaluated with logistic regression analysis for their ability to select patients requiring a relaparotomy: APACHE-II score, SAPS-II, Mannheim Peritonitis Index (MPI), MODS, SOFA score, and the acute part of the APACHE-II score (APS).ResultsThe proportion of patients requiring a relaparotomy was 32% (71/221). Only 2 scores had a discriminatory ability in identifying patients with ongoing infection needing relaparotomy above chance: the APS on day 1 (AUC 0.61; 95%CI 0.52-0.69) and the SOFA score on day 2 (AUC 0.60; 95%CI 0.52-0.69). However, to correctly identify 90% of all patients needing a relaparotomy would require such a low cut-off value that around 80% of all patients identified by these scoring systems would have negative findings at relaparotomy.ConclusionsNone of the widely-used scoring systems to predict overall outcome in critically ill patients are of clinical value for the identification of patients with ongoing infection needing relaparotomy. There is a need to develop more specific tools to assist physicians in their daily monitoring and selection of these patients after the initial emergency laparotomy.Trial registration numberISRCTN: ISRCTN 51729393

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Section: Discussionmentioning

confidence: 99%

Failure of available scoring systems to predict ongoing infection in patients with abdominal sepsis after their initial emergency laparotomy

et al. 2011

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“…In our study we want to demonstrate efficacy of MPI and the possibility to consider older age an independent prognostic factor, analysing a perforative peritonitis population with high percentage of older patients (16)(17)(18).…”

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confidence: 99%

Mannheim Peritonitis Index (MPI) and elderly population: prognostic evaluation in acute secondary peritonitis

Salamone¹,

Licari²,

Falco³

et al. 2016

Gchir

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“…We found that the overall incidence of intestinal perforation was low, at 4.6 events per 1,000 person years, while nearly half of the patients (42%) who experienced an intestinal perforation died within 30 days. The overall in-hospital mortality rates of intestinal perforation were 10%–20% in the general population (1–6). We also tested whether the incidence of intestinal perforation changed after market introduction of sevelamer hydrochloride in late 1998, a hypothesis that was motivated by safety concerns that had previously been weighed by the US FDA.…”

Section: Discussionmentioning

confidence: 99%

“…Intestinal perforation is rare in the general population, but carries a high risk of mortality (1–6). We recently observed that patients undergoing dialysis had high rates of acute nonvariceal gastrointestinal bleeding, which was up to 2 orders of magnitude higher than in the nondialysis population (7).…”

Section: Introductionmentioning

confidence: 99%

Trends in the incidence of intestinal perforation in US dialysis patients (1992-2005)

Yang

Lee²,

Montez‐Rath³

et al. 2012

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Background Little is known about the incidence of intestinal perforation in patients undergoing dialysis. Concerns exist that sevelamer hydrochloride may increase the risk of intestinal perforation. We examined long-term trends for the incidence of intestinal perforation among US dialysis patients. Methods We studied all dialysis patients (1992–2005) who had Medicare as primary payer. We used ICD-9 diagnosis code 569.83 to ascertain events of intestinal perforation. We studied (a) all perforations and (b) perforations that did not appear to be associated with specific causative conditions (specific diseases or iatrogenic procedures within 7 days of perforation). We used Poisson regression to model the annual number of intestinal perforations and tested for any changes in levels and temporal trends of incidence rates before versus after January 1, 1999. Results Overall, 1,060,132 patients contributed 2.7 million patient-years. We observed 12,355 events of intestinal perforation and 7,814 spontaneous perforations. The corresponding incidence rates were 4.6 (total) and 2.9 (spontaneous perforation) episodes per 1,000 person-years, respectively. For both outcome definitions, 30-day mortality was 42%. Unadjusted and adjusted incidence rates were not materially different over time. Formal tests for any changes in the level or slope of incidence comparing time periods before and after January 1, 1999, indicated no evidence for any changes in the incidence of intestinal perforation over time. Conclusions In US dialysis patients, incidence of intestinal perforation was low, but associated with high short-term mortality. We did not detect any significant changes in the incidence of intestinal perforation before versus after approval of sevelamer hydrochloride in late 1998.

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Predictors of Outcome Following Surgery in Colonic Perforation: An Institution’s Experience Over 6 Years

Abstract: Surgery for colonic perforation is associated with high morbidity and mortality rates. Short-term outcome is determined by ASA score and severity of peritonitis. A lower haematocrit level must alert the possibility of malignancy.

Cited by 31 publications

References 38 publications

Failure of available scoring systems to predict ongoing infection in patients with abdominal sepsis after their initial emergency laparotomy

Failure of available scoring systems to predict ongoing infection in patients with abdominal sepsis after their initial emergency laparotomy

Mannheim Peritonitis Index (MPI) and elderly population: prognostic evaluation in acute secondary peritonitis

Trends in the incidence of intestinal perforation in US dialysis patients (1992-2005)

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