Prognostic impact of postoperative management by an intensive care unit intensivist after colonic perforation.
Colonic perforation
Intensivist
Prognosis
Sepsis
Journal
Langenbeck's archives of surgery
ISSN: 1435-2451
Titre abrégé: Langenbecks Arch Surg
Pays: Germany
ID NLM: 9808285
Informations de publication
Date de publication:
25 Oct 2024
25 Oct 2024
Historique:
received:
26
07
2024
accepted:
16
10
2024
medline:
25
10
2024
pubmed:
25
10
2024
entrez:
25
10
2024
Statut:
epublish
Résumé
Postoperative management for colonic perforation is an important prognostic factor, but whether intensivists perform postoperative management varies between institutions. We investigated 291 patients with colonic perforation between 2018 and 2022. Patients were divided into those managed by an intensivists (ICU group; n = 40) and those not managed by an intensivists (non-ICU group; n = 251). We examined how management by intensivists affected prognosis using inverse probability weighting, and clarified which patients should consult an intensivists. The ICU group showed a significantly higher shock index (1.15 vs. 0.75, p < 0.01), higher APACHE II score (16.0 vs. 10.0, p < 0.001), and more severe comorbidities (Charlson Comorbidity Index 5.0 vs. 1.0, p < 0.001) and general peritonitis (85% vs. 38%, p < 0.001). Adjusted risk differences were - 24% (-34% to -13%) for 6-month mortality rate. Six-month mortality was improved by ICU intensivist management in patients with general peritonitis (risk difference - 22.8; 95% confidence interval - 34 to -11); APACHE II score ≥20 (-0.79; -1.06 to -0.52); lactate ≥1.6 (-0.38; -0.57 to -0.29); shock index ≥1.0 (-40.01; -54.87 to -25.16); and catecholamine index ≥10 (-41.16; -58.13 to -24.19). Intensivists were involved in treating patients in poor general condition, but prognosis was extremely good. Appropriate case consultation with intensivists is important.
Identifiants
pubmed: 39453495
doi: 10.1007/s00423-024-03516-4
pii: 10.1007/s00423-024-03516-4
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
325Informations de copyright
© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.
Références
Wickel DJ, Cheadle WG, Mercer-Jones MA, Garrison RN (1997) Poor outcome from peritonitis is caused by disease acuity and organ failure, not recurrent peritoneal infection. Ann Surg 225(6):744–753 discussion 753–756
doi: 10.1097/00000658-199706000-00012
pubmed: 9230815
pmcid: 1190882
Sivaram P, Sreekumar A (2018) Preoperative factors influencing mortality and morbidity in peptic ulcer perforation. Eur J Trauma Emerg Surg 44(2):251–257
doi: 10.1007/s00068-017-0777-7
pubmed: 28258286
Kocer B, Surmeli S, Solak C, Unal B, Bozkurt B, Yildirim O et al (2007) Factors affecting mortality and morbidity in patients with peptic ulcer perforation. J Gastroenterol Hepatol 22(4):565–570
doi: 10.1111/j.1440-1746.2006.04500.x
pubmed: 17376052
Ye-Ting Z, Dao-Ming T (2018) Systemic inflammatory response syndrome (SIRS) and the pattern and risk of sepsis following gastrointestinal perforation. Med Sci Monit 24:3888–3894
doi: 10.12659/MSM.907922
pubmed: 29884777
pmcid: 6024714
Becher RD, DeWane MP, Sukumar N, Stolar MJ, Gill TM, Maung AA et al (2020) Hospital volume and operative mortality for general surgery operations performed emergently in adults. Ann Surg 272(2):288–303
doi: 10.1097/SLA.0000000000003232
pubmed: 32675542
Durairaj L, Torner JC, Chrischilles EA, Vaughan Sarrazin MS, Yankey J, Rosenthal GE (2005) Hospital volume-outcome relationships among medical admissions to ICUs. Chest 128(3):1682–1689
doi: 10.1378/chest.128.3.1682
pubmed: 16162775
Knaus WA, Draper EA, Wagner DP, Zimmerman JE (1985) APACHE II: a severity of disease classification system. Crit Care Med 13(10):818–829
doi: 10.1097/00003246-198510000-00009
pubmed: 3928249
Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40(5):373–383
doi: 10.1016/0021-9681(87)90171-8
pubmed: 3558716
Shiba K, Kawahara T (2021) Using propensity scores for causal inference: pitfalls and tips. J Epidemiol 31(8):457–463
doi: 10.2188/jea.JE20210145
pubmed: 34121051
pmcid: 8275441
Austin PC (2011) An introduction to propensity score methods for reducing the effects of confounding in observational studies. Multivar Behav Res 46(3):399–424
doi: 10.1080/00273171.2011.568786
Granger E, Sergeant JC, Lunt M (2019) Avoiding pitfalls when combining multiple imputation and propensity scores. Stat Med 38(26):5120–5132
doi: 10.1002/sim.8355
pubmed: 31512265
pmcid: 6856837
Yilmazlar T, Toker S, Zorluoğlu A (1999) Non-traumatic colorectal perforations. Int Surg 84(2):155–158
pubmed: 10408288
Bielecki K, Kamiński P, Klukowski M (2002) Large bowel perforation: morbidity and mortality. Tech Coloproctol 6(3):177–182
doi: 10.1007/s101510200039
pubmed: 12525912
Tan KK, Hong CC, Zhang J, Liu JZ, Sim R (2011) Predictors of outcome following surgery in colonic perforation: an institution’s experience over 6 years. J Gastrointest Surg 15(2):277–284
doi: 10.1007/s11605-010-1330-8
pubmed: 20824374
Chen H, Zhang H, Li W, Wu S, Wang W (2015) Acute gastrointestinal injury in the intensive care unit: a retrospective study. Ther Clin Risk Manag 11:1523–1529
pubmed: 26491339
pmcid: 4599567
Pronovost PJ, Angus DC, Dorman T, Robinson KA, Dremsizov TT, Young TL (2002) Physician staffing patterns and clinical outcomes in critically ill patients: a systematic review. JAMA 288(17):2151–2162
doi: 10.1001/jama.288.17.2151
pubmed: 12413375
Wise KR, Akopov VA, Williams BR Jr., Ido MS, Leeper KV Jr., Dressler DD (2012) Hospitalists and intensivists in the medical ICU: a prospective observational study comparing mortality and length of stay between two staffing models. J Hosp Med 7(3):183–189
doi: 10.1002/jhm.972
pubmed: 22069304
Wallace DJ, Angus DC, Barnato AE, Kramer AA, Kahn JM (2012) Nighttime Intensivist staffing and mortality among critically ill patients. N Engl J Med 366(22):2093–2101
doi: 10.1056/NEJMsa1201918
pubmed: 22612639
pmcid: 3979289
Brunot V, Landreau L, Corne P, Platon L, Besnard N, Buzançais A, Daubin D, Serre JE, Molinari N, Klouche K (2016) Mortality Associated with Night and Weekend admissions to ICU with On-Site Intensivist Coverage: results of a nine-year Cohort Study (2006–2014). PLoS ONE 11(12):e0168548
doi: 10.1371/journal.pone.0168548
pubmed: 28033395
pmcid: 5199040
The Japanese Society of Intensive Care Medicine, Committee of Social Insurance Revision of the intensive care unit fee in 2014 [Internet]. 2014 [cited 2021 Mar 31]. https://www.jsicm.org/pdf/ICUsinnryou2014.pdf . Japanese
Ministry of Health, Labour and Welfare, Japan. Japan Ministry of Health, Labour and Welfare Statistical Surveys 2017 [Internet]. 2017 [cited 2021 Mar 31]. https://www.mhlw.go.jp/stf/seisakunitsuite/bunya/open_data.html . Japanese
Shime N (2016) Clinical and investigative critical care medicine in Japan. Intensive Care Med 42(3):453–455
doi: 10.1007/s00134-015-4165-7
pubmed: 26762107
The Japanese Society of Intensive Care Medicine, Committee of Japanese ICU Evaluation (2011) Influence of staffing and administrative policy of ICU on patient outcome. J Jpn Soc Intensive Care Med 18(2):283–294
doi: 10.3918/jsicm.18.283
Uchino S (2011) Are Japanese ICUs properly utilized? J Jpn Soc Intensive Care Med 17(2):141–144
doi: 10.3918/jsicm.17.141
Sasabuchi OH, Matsui Y, Fushimi H, Yasunaga K (2021) Resource-rich Intensive Care Units vs. Standard Intensive Care units on patient mortality: a Nationwide Inpatient Database Study. JMA J 4(4):397–404
pubmed: 34796294
pmcid: 8580699
de Groot V, Beckerman H, Lankhorst GJ, Bouter LM (2003) How to measure comorbidity. A critical review of available methods. J Clin Epidemiol 56(3):221–229
doi: 10.1016/S0895-4356(02)00585-1
pubmed: 12725876
Asai N, Ohashi W, Sakanashi D, Suematsu H, Kato H, Hagihara M et al (2021) Combination of sequential organ failure Assessment (SOFA) score and Charlson Comorbidity Index (CCI) could predict the severity and prognosis of candidemia more accurately than the Acute Physiology, Age, Chronic Health evaluation II (APACHE II) score. BMC Infect Dis 21(1):77
doi: 10.1186/s12879-020-05719-8
pubmed: 33451284
pmcid: 7811217
Jouffroy R, Gilbert B, Thomas L, Bloch-Laine E, Ecollan P, Boularan J et al (2022) Association between prehospital shock index variation and 28-day mortality among patients with septic shock. BMC Emerge Med 22(1):87
doi: 10.1186/s12873-022-00645-1
Coopersmith CM, De Backer D, Deutschman CS, Ferrer R, Lat I, Machado FR et al (2018) Surviving sepsis campaign: research priorities for sepsis and septic shock. Int Care Med 44(9):1400–1426
doi: 10.1007/s00134-018-5175-z
Junhasavasdikul D, Theerawit P, Ingsathit A, Kiatboonsri S (2016) Lactate and combined parameters for triaging sepsis patients into intensive care facilities. J Crit Care 33:71–77
doi: 10.1016/j.jcrc.2016.01.019
pubmed: 26947750
Liu X, Shen Y, Li Z, Fei A, Wang H, Ge Q et al (2016) Prognostic significance of APACHE II score and plasma suPAR in Chinese patients with sepsis: a prospective observational study. BMC Anesthesiol 16(1):46
doi: 10.1186/s12871-016-0212-3
pubmed: 27473112
pmcid: 4966698
Suo S, Luo L, Song Y, Huang H, Chen X, Liu C Early diagnosis and prediction of death risk in patients with sepsis by combined detection of serum PCT, BNP, lactic acid, and APACHE II score. Contrast media & molecular imaging 2022;2022:8522842.
Teseng J, Nugent K (2015) Utility of the shock index in patients with sepsis. Am J Med Sci 349(6):531–535
doi: 10.1097/MAJ.0000000000000444
Nassour I, Fang SH (2015) Gastrointestinal perforation. JAMA Surg 150(2):177–178
doi: 10.1001/jamasurg.2014.358
pubmed: 25549241
Taş İ, Ülger BV, Önder A, Kapan M, Bozdağ Z (2015) Risk factors influencing morbidity and mortality in perforated peptic ulcer disease. Ulusal Cerrahi Dergisi 31(1):20–25
pubmed: 25931940