Differences in Morbidity and Mortality with Percutaneous versus Open Surgical Drainage of Postoperative Intra-abdominal Infections: A Review of 686 Cases

• Published in: The American surgeon 2011-07, Vol.77 (7), p.862-867
• Main Authors: POLITANO, Amani D, HRANJEC, Tjasa, ROSENBERGER, Laura H, SAWYER, Robert G, TACHE LEON, Carlos A
• Format: Article
• Language: English
• Subjects: Abdomen - surgery; Antibiotics; Biological and medical sciences; Data collection; Disease; Drainage - adverse effects; Drainage - methods; Epidemiology; Failure; Female; General aspects; Hospitalization; Humans; Illnesses; Infection - etiology; Infection - mortality; Infection - surgery; Inflammatory bowel disease; Male; Medical sciences; Methods; Middle Aged; Mortality; Multivariate analysis; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Postoperative Complications - mortality; Prospective Studies; Public health. Hygiene; Public health. Hygiene-occupational medicine; Regression analysis
• ISSN: 0003-1348; 1555-9823
• DOI: 10.1177/000313481107700720

Intra-abdominal infections following surgical procedures result from organ-space surgical site infections, visceral perforations, or anastomotic leaks. We hypothesized that open surgical drainage is associated with increased patient morbidity and mortality compared with percutaneous drainage. A single-institution, prospectively collected database over a 13-year period revealed 2776 intra-abdominal infections, 686 of which required an intervention after the index operation. Percutaneous procedures (simple aspiration or catheter placement) were compared with all other open procedures by univariate and multivariate analyses. Analysis revealed 327 infections in 240 patients undergoing open surgical drainage and 359 infections in 260 patients receiving percutaneous drainage. Those undergoing open drainage had significantly higher Acute Physiology Score (APS) and Acute Physiology and Chronic Health Evaluation (APACHE) II scores and were more likely to be immunosuppressed, require intensive care unit treatment, and have longer hospital stays. Mortality was higher in the open group: 14.6 versus 4.2 per cent (P = 0.0001). Variables independently associated with death by multivariate analysis were APACHE II, dialysis, intensive care unit (ICU) care, age, immunosuppression, and drainage method. Open intervention for postsurgical intra-abdominal infections is associated with increased mortality compared with percutaneous drainage even after controlling for severity of illness by multivariate analysis. Although some patients are not candidates for percutaneous drainage, it should be considered the preferential treatment in eligible patients.