Time from admission to initiation of surgery for source control is a critical determinant of survival in patients with gastrointestinal perforation with associated septic shock

Abstract

IntroductionWe developed a protocol to initiate surgical source control immediately after admission (early source control) and perform initial resuscitation using early goal-directed therapy (EGDT) for gastrointestinal (GI) perforation with associated septic shock. This study evaluated the relationship between the time from admission to initiation of surgery and the outcome of the protocol.MethodsThis examination is a prospective observational study and involved 154 patients of GI perforation with associated septic shock. We statistically analyzed the relationship between time to initiation of surgery and 60-day outcome, examined the change in 60-day outcome associated with each 2 hour delay in surgery initiation and determined a target time for 60-day survival.ResultsLogistic regression analysis demonstrated that time to initiation of surgery (hours) was significantly associated with 60-day outcome (Odds ratio (OR), 0.31; 95% Confidence intervals (CI)), 0.19-0.45; P <0.0001). Time to initiation of surgery (hours) was selected as an independent factor for 60-day outcome in multiple logistic regression analysis (OR), 0.29; 95% CI, 0.16-0.47; P <0.0001). The survival rate fell as surgery initiation was delayed and was 0% for times greater than 6 hours.ConclusionsFor patients of GI perforation with associated septic shock, time from admission to initiation of surgery for source control is a critical determinant, under the condition of being supported by hemodynamic stabilization. The target time for a favorable outcome may be within 6 hours from admission. We should not delay in initiating EGDT-assisted surgery if patients are complicated with septic shock.

Association of delay of urgent or emergency surgery with mortality and use of health care resources: a propensity score–matched observational cohort study

“…29 Among emergency laparotomies, 77% of delays were related to being bumped by higher-priority cases or unavailability of operating rooms. 28 Although our results support the known association between delay and mortality in patients with hip fracture, 7 they also support the generalizability of the delay-outcome association to nonorthopedic surgery, where previous findings have both supported 8,9 and refuted 10,11 this association. There are about 100 000 emergency general surgery operations, 31 and 30 000 hip fracture operations annually in Canada.…”

“…In hip fracture surgery, delay is associated with morbidity and mortality, 6,7 but for other surgeries, the effect of delay on outcomes is unclear. [8][9][10][11][12][13] Because it is very expensive to expand or reorganize operating room resources to improve access, [14][15][16] understanding the relation between delay and outcomes for all types of emergency surgery is needed.…”

Association between surgical delay and survival in high-risk emergency abdominal surgery. A population-based Danish cohort study

“…In patients with perforated peptic ulcer, surgical delay has recently been shown to be a critical determinant of survival with an estimated 2.4% decreased probability of survival with every hour of surgical delay [11]. Data on the association between surgical delay and outcome in emergency major abdominal surgery in general are sparse [11,12]. Data on this topic may provide important clinically relevant knowledge, as symptoms and findings in patients undergoing emergency abdominal surgery are often non-disease specific, and diagnosis is frequently not firm until surgery is done.…”

Advances in Intra-abdominal Sepsis: What Is New?

“…Azuhata et al enrolled 154 patients with gastrointestinal perforation and associated septic shock over a 5-year period to evaluate the relationship between time to source control and survival at 60 days [22]. Patients were managed with a protocol that included early goal-directed therapy (EGDT) and surgical intervention as soon as possible.…”