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ISSN 1527-3172 (Electronic)

2017, Number 4

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MEDICC Review 2017; 19 (4)

Predicting abdominal surgery mortality: a model based on intra-abdominal pressure

Soler-Morejón CD, Lombardo-Vaillant TA, Tamargo-Barbeito TO, LNG Malbrain M

Language: English
References: 48
Page: 16-20
PDF size: 108.29 Kb.


ABSTRACT

Introduction Early assessment of prognosis following major abdominal surgery is associated with decreased risk of complications and death. While scoring systems are useful in this regard, there is no index that enables comprehensive individual patient assessment and is also applicable in ICUs with limited resources.
Objectives Demonstrate that a model based on intra-abdominal pressure is effective in predicting death after major abdominal surgery.
Methods A prospective observational study was done of 300 post–abdominal-surgery patients admitted to the ICU of a university hospital affiliated with the General Calixto García Medical Faculty, in January 2008 through January 2010. Patients were randomly assigned (2:1) to two groups: test and validation. The independent variable was vital status at discharge (alive or deceased); independent variables were age, sex, malignancy, APACHE II score and intra-abdominal pressure. In the test group, three mathematical models were fit to predict death (APACHE II, intra-abdominal pressure, and APACHE II plus intra-abdominal pressure), which were later validated in the second group. Each model’s capacity to discriminate between living and deceased was evaluated according to sensitivity and specificity of receiver operating characteristic curves. Calibration was assessed with the Hosmer–Lemeshow goodness-of-fit test and comparison of receiver operating characteristic curves by chi-square test of homogeneity. Each patient was followed until hospital discharge or death.
Results The three mortality prediction models displayed excellent calibration and discrimination, very similar predictive power, and no differences among their respective areas under the curve (chi square 2.802, p = 0.094). Variables with the most influence on probability of death were age, APACHE II score and intra-abdominal pressure.
Conclusions The three models show good capacity and similar effectiveness to predict death after major abdominal surgery. The model based on intra-abdominal pressure is the most feasible in limited-resource settings.


REFERENCES

  1. Sartelli M, Catena F, Abu-Zidan FM, Ansaloni L, Biffl WL, Boermeester MA, et al. Management of intra-abdominal infections: recommendations by the WSES 2016 consensus conference. World J Emerg Surg. 2017 May 4;12:22.

  2. Pusajó JF, Bumaschny E, Doglio GR, Cherjovsky MR, Lipinszki AI, Hernández MS, et al. Postoperative intraabdominal sepsis requiring reoperation. Arch Surg. 1993 Feb;128(2):218–22.

  3. Cheadle WG, Spain DA. The continuing challenge of intra-abdominal infection. Am J Surg. 2003 Nov 28;186(5A):15S–22S.

  4. Bader FG, Schröder M, Kujath P, Muhl E, Bruch HP, Eckmann C. Diffuse postoperative peritonitis – value of diagnostic parameters and impact of early indication for relaparotomy. Eur J Med Res. 2009 Nov 3;14:491–6.

  5. Xiao Z, Wilson C, Robertson HL, Roberts DJ, Bal CG, Jenne CN. Infl ammatory mediators in intraabdominal sepsis or injury – a scoping review. Crit Care. 2015 Oct 27;19:373.

  6. Straatman J, Cuesta MA, Schreurs WH, Dwars BJ, Cense HA, Rijna H, et al. The PRECious trial PREdiction of Complications, a step-up approach, CRP fi rst followed by CT-scan imaging to ensure quality control after major abdominal surgery: study protocol for a stepped-wedge trial. Trials. 2015 Aug 28;16:382.

  7. Sartelli M. A focus on intra-abdominal infections. World J Emerg Surg [Internet]. 2010 Mar 19 [cited 2017 Jun 19];5:9. Available from: http://www .wjes.org/content/5/1/9

  8. La Rosa Armero Y, Matos Tamayo ME, Rodríguez Fernández Z. Características de las reintervenciones en un servicio de cirugía general. MEDISAN [Internet]. 2017 [cited 2017 Jun 19];21(2):192. Available from: http://medisan .sld.cu/index.php/san/article/view/1234/pdf. Spanish.

  9. Giaccaglia V, Salvi PF, Cunsolo GV, Sparagna S, Antonelli MS, Nigri G, et al. Procalcitonin, as an early biomarker of colorectal anastomotic leak, facilitates enhanced recovery after surgery. J Crit Care [Internet]. 2014 Aug [cited 2017 Jun 19];29(4):528–32. Available from: http://dx.doi .org/10.1016/j.jcrc.2014.03.036

  10. Wacha H, Linder MM, Feldman U, Steinfensand RA. Mannheim Peritonitis Index: Prediction of risk of death from peritonitis. Construction of a statistical and validation of an empirically based index. Theoret Surg. 1987 Jan;1:169–77.

  11. Biondo S, Ramos E, Fragealvitri D, Kreisler E, Ragué JM, Jaurrieta E. Comparative study of left colonic Peritonitis Severity Score and Mannheim Peritonitis Index. Br J Surg. 2006 May;93(5):616–22.

  12. Knaus WA, Zimmerman JE, Wagner DP, Draper EA, Lawrence DE. APACHE acute physiology and chronic health evaluation a physiologically based classifi cation system. Crit Care Med.1981 Aug;9(8):591–7.

  13. Ramsay JR, Mac G, Murray GD. Prediction of surgical risk in adults. Surg Res Comm.1988;3:95103.

  14. Koperna T, Schulz F. Relaparotomy in peritonitis: prognosis and treatment of patients with persisting intra-abdominal infection. World J Surg. 2000 Jan;24(1):32–7.

  15. Gil-Bona J, Sabaté A, Miguelena Bovadilla JM, Romà Adroer R, Koo M, Jaurrieta E. Valor de los índices de Charlson y la escala de riesgo quirúrgico en el análisis de la mortalidad operatoria. Cir Esp [Internet]. 2010 Sep 1 [cited 2017 Jan 5];88(3):174–9. Available from: http:// www.elsevier.es/es-revista-cirugia-espanola -36-articulo-valor-los-indices-charlson-escala -S0009739X10002897 - aff2. Spanish.

  16. Torer N, Yorganci K, Elker D, Sayek I. Prognostic factors of the mortality of postoperative intraabdominal infections. Infection. 2010 Aug;38(4):255–60.

  17. Martínez-Casas I, Sancho JJ, Nve E, Pons MJ, Membrilla E, Grande L. Preoperative risk factors for mortality after relaparotomy: analysis of 254 patients. Langenbecks Arch Surg. 2010 Jun;39(5):527–34.

  18. Berreta J, Kociak D, Balducci A, De Feo F, Laplacette MV, Bellido F, et al. Peritonitis secundaria generalizada: predictores de mortalidad, sobrevida y vinculantes evolutivos. Acta Gastroenterol Latinoam. 2010 Jun;40(2):105–16. Spanish.

  19. Davis P, Hayden J, Springer J, Bailey J, Molinari M, Johnson P. Prognostic factors for morbidity and mortality in elderly patients undergoing acute gastrointestinal surgery: a systematic review. Can J Surg. 2014 Apr;57(2):E44–52. English, French.

  20. Stommel MWJ, de Wilt JH, ten Broek RP, Strik C, Rovers MM, van Goor H. Prior Abdominal Surgery Jeopardizes Quality of Resection in Colorectal Cancer. World J Surg. 2016 May 6;40(5):1246–54.

  21. Kwak BJ, Kim SC, Song KB, Lee JH, Hwang DW, Park KM, et al. Prognostic factors associated with early mortality after surgical resection for pancreatic adenocarcinoma. Korean J Hepatobiliary Pancreat Surg. 2014 Nov;18(4):138–46.

  22. Unver M, Fırat Ö, Ünalp ÖV, Uğuz A, Gümüş T, Sezer TÖ, et al. Prognostic factors in peptic ulcer perforations: a retrospective 14-year study. Int Surg. 2015 May;100(5):942–8.

  23. Basu A, Pai DR. Early elevation of intra-abdominal pressure after laparotomy for secondary peritonitis: a predictor of relaparotomy? World J Surg. 2008 Aug;32(8):1851–6.

  24. Khan S, Verma AK, Ahmad SM, Ahmad R. Analyzing intra-abdominal pressures and outcomes in patients undergoing emergency laparotomy. J Emerg Trauma Shock. 2010 Oct;3(4):318–25.

  25. Kirkpatrick AW, Roberts DJ, De Waele J, Jaeschke R, Malbrain ML, De Keulenaer B, et al. Intra-abdominal hypertension and the abdominal compartment syndrome: updated consensus defi nitions and clinical practice guidelines from the World Society of the Abdominal Compartment Syndrome. Intensive Care Med. 2013 Jul; 39(7):1190–206.

  26. Reyes de la Paz A, Lombardo Vaillant TA, Rubio Olivares DY. Valor predictivo de la presión intra-abdominal en el diagnóstico de complicaciones posoperatorias abdominales. Rev Cub Med Mil [Internet]. 2007 Oct–Dec [cited 2017 Apr 20];36(4). Available from: http://scielo .sld.cu/scielo.php?script=sci_arttext&pid =S0138-65572007000400003. Spanish.

  27. Sartelli M, Viale P, Catena F, Ansaloni L, Moore E, Malangoni M, et al. 2013 WSES guidelines for management of intra-abdominal infections. World J Emerg Surg. 2013 Jan 8;8(1):3.

  28. Holodinsky JK, Roberts DJ, Ball CG, Blaser AR, Starkopf J, Zygun DA, et al. Risk factors for intraabdominal hypertension and abdominal compartment syndrome among adult intensive care unit patients: a systematic review and meta-analysis. Crit Care. 2013;17(5):R249.

  29. Chow AW, Evans GA, Nathens AB, Ball CG, Hansen G, Harding GK, et al. Canadian practice guidelines for surgical intra-abdominal infections. Can J Infect Dis Med Microbiol. 2010;21(1):11– 37.

  30. Sartelli M, Catena F, Di Saverio S, Ansaloni L, Malangoni M, Moore EE, et al. Current concept of abdominal sepsis: WSES position paper. World J Emerg Surg. 2014 Mar 27;9(1):22.

  31. Leppäniemi A, Kimball EJ, De Laet I, Malbrain ML, Balogh ZJ, De Waele JJ. Management of abdominal sepsis — a paradigm shift? Anaesthesiol Intensive Ther. 2015;47(4):400–8.

  32. Khan S, Verma AK, Ahmad SM, Ahmad R. Analyzing intra-abdominal pressures and outcomes in patients undergoing emergency laparotomy. J Emerg Trauma Shock. 2010 Oct;3(4):318–25.

  33. Cheatham ML, Safcsak K. Intra-abdominal pressure: a revised method for measurement. J Am Coll Surg. 1998;186(5):594–5.

  34. Swets JA. Measuring the accuracy of diagnostic systems. Science. 1988 Jun 3;240(4857):1285– 93.

  35. Hosmer DW, Lemeshow S. Applied Logistic Regression. New York: John Wiley & Sons Inc.; 1989. 307 p.

  36. World Medical Association Declaration of Helsinki. Ethical principles for medical research involving human subject. 59th WMA General Assembly, Seoul, October 2008 [Internet]. Ferney-Voltaire (FR): WMA; 2008 [cited 2017 Apr 17]. Available from: http://irb.sinica.edu .tw/doc/regulation/DECLARATION%20OF%20 HELSINKI%20%282013%29.pdf

  37. Azoulay E, Afessa B. The intensive care support of patients with malignancy: do everything that can be done. Intensive Care Med. 2006 Jan;32(1):3–5.

  38. Hartl WH, Wolf H, Schneider CP, Küchenhoff H, Jauch KW. Acute and long-term survival in chronically critically ill surgical patients: a retrospective observational study. Crit Care. 2007;11(3):R55.

  39. Cheng J, Wei Z, Liu X, Li X, Yuan Z, Zheng J, et al. The role of intestinal mucosa injury induced by intra-abdominal hypertension in the development of abdominal compartment syndrome and multiple organ dysfunction syndrome. Crit Care. 2013 Dec 9;17(6):R283.

  40. Kirkpatrick AW, Roberts DJ, De Waele J, Laupland K. Is intra-abdominal hypertension a missing factor that drives multiple organ dysfunction syndrome? Crit Care. 2014 Mar 19;18(2):124.

  41. Hatipoglu S, Akbulut S, Hatipoglu F, Abdullayev R. Effect of laparoscopic abdominal surgery on splanchnic circulation: Historical developments. World J Gastroenterol. 2014 Dec 28;20(48):18165–76.

  42. Smith M, Buddingh KT, Bosma B, Nieuwenhuijs VB, Hofker HS, Zijlstra JG. Abdominal Compartment Syndrome and Intra-abdominal Ischemia in Patients with Severe Acute Pancreatitis. World J Surg. 2016 Jun;40(6):1454 l–61.

  43. Kirkpatrick AW, McBeth PB, Ball CG, Ejike JC, De Laet IE, Nickerson D. Mesenteric ischemia, intra-abdominal hypertension, and the abdominal compartment syndrome. Plastic Surg (Oakv). 2016 Spring;24(1):9–10.

  44. Unalp HR, Kamer E, Kar H, Bal A, Peskersoy M, Ali Onal M. Urgent abdominal re-explorations. World J Emerg Surg. 2006 Apr 4;1:10.

  45. Reintam A, Parm P, Kitus R, Kern H, Starkopf J. Primary and secondary intra-abdominal hypertension– different impact on ICU outcome. Intensive Care Med. 2008 Sep;34(9):1624–31.

  46. Domínguez AH, Acuña Collazos JA, Toro Ocampo EM. Una comparación entre métodos estadísticos clásicos y técnicas metaheurísticas en el modelamiento estadístico. Scientia et Technica. 2012;(50):68–77. Spanish.

  47. Pons JMV, Argimón JM. De la parsimonia en medicina. Med Clin [Internet]. 2013 Nov [cited 2017 May 5];141(9):387–89. Available from: http:// www.elsevier.es/es-revista-medicina-clinica -2-articulo-de-parsimonia-medicina-S00257753 1300359X. Spanish.

  48. Carmelo Dueñas C. El juicio clínico en cuidado intensivo ¿Es útil para tomar decisiones y predecir pronósticos? [Internet]. Cartagena de Indias: Unidad de Cuidado Intensivo, Universidad de Cartagena; [cited 2017 April 17]; [about 2 screens]. Available from: http://www.angelfi re .com/space2/fjr/221_juicio_clinico_en_uci.htm. Spanish.




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