Rate of stoma formation following damage-control surgery for severe intra-abdominal sepsis: a single-centre consecutive case series.

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Version: Final published version
License: CC BY-NC 4.0
Serval ID
serval:BIB_DBE559653A40
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Rate of stoma formation following damage-control surgery for severe intra-abdominal sepsis: a single-centre consecutive case series.
Journal
BJS open
Author(s)
Faes S., Hübner M., Girardin T., Demartines N., Hahnloser D.
ISSN
2474-9842 (Electronic)
ISSN-L
2474-9842
Publication state
Published
Issued date
09/11/2021
Peer-reviewed
Oui
Volume
5
Number
6
Pages
zrab106
Language
english
Notes
Publication types: Journal Article
Publication Status: ppublish
Abstract
Severe intra-abdominal sepsis (IAS) is associated with high mortality and stoma rates. A two-stage approach with initial damage-control surgery (DCS) and subsequent reconstruction might decrease stoma and mortality rates but requires standardization.
A standardized two-stage damage-control algorithm for IAS was implemented in April 2016 and applied systematically.
Some 203 consecutive patients (median age 70 years, 62 per cent ASA score greater than 3) had DCS for severe IAS. Median operation time was 82 minutes, 60 per cent performed during night-time. Median intraoperative noradrenaline doses were 20 (i.q.r. 26) µg/min and blood gas analysis (ABG) was abnormal (metabolic acidosis) in 90 per cent of patients. The second-stage operation allowed definitive surgery in 76 per cent of patients, 24 per cent had up to four re-DCSs until definitive surgery. The in-hospital mortality rate was 26 per cent. At hospital discharge, 65 per cent of patients were stoma free. Risk factors for in-hospital death were noradrenaline (odds ratio 4.25 (95 per cent c.i. 1.72 to 12.83)), abnormal ABG (pH: odds ratio 2.72 (1.24 to 6.65); lactate: odds ratio 6.77 (3.20 to 15.78)), male gender (odds ratio 2.40 (1.24 to 4.85)), ASA score greater than 3 (odds ratio 5.75 (2.58 to 14.68)), mesenteric ischaemia (odds ratio 3.27 (1.71 to 6.46)) and type of resection (odds ratio 2.95 (1.24 to 8.21)). Risk factors for stoma at discharge were ASA score greater than 3 (odds ratio 2.76 (95 per cent c.i. 1.38 to 5.73)), type of resection (odds ratio 30.91 (6.29 to 559.3)) and longer operation time (odds ratio 2.441 (1.22 to 5.06)).
Initial DCS followed by secondary reconstruction of bowel continuity for IAS within 48 hours in a tertiary teaching hospital was feasible and safe, following a clear algorithm.
Keywords
General Medicine
Pubmed
Open Access
Yes
Create date
09/11/2021 12:00
Last modification date
12/01/2022 7:14
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