Surgical treatment of patients with abdominal sepsis taking into account the prediction of the implementation of re-operations
Objective. The investigation objective was improvement of the surgical treatment results in patients, suffering аbdominal sepsis, using individualized tactics of treatment, taking into account a possibility for the postoperative complications occurrence and the treatment results prognostication....
| Main Authors: | , , , |
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| Format: | Article |
| Language: | Russian |
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Liga-Inform ltd.
2020-05-01
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| Series: | Клінічна хірургія |
| Subjects: | |
| Online Access: | https://hirurgiya.com.ua/index.php/journal/article/view/781 |
| _version_ | 1827959885889798144 |
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| author | I. A. Kryvoruchko M. S. Antonova O. V. Yevtushenko S. A. Andreieshchev |
| author_facet | I. A. Kryvoruchko M. S. Antonova O. V. Yevtushenko S. A. Andreieshchev |
| author_sort | I. A. Kryvoruchko |
| collection | DOAJ |
| description | Objective. The investigation objective was improvement of the surgical treatment results in patients, suffering аbdominal sepsis, using individualized tactics of treatment, taking into account a possibility for the postoperative complications occurrence and the treatment results prognostication.
Маterials and methods. The results of treatment of the adult patients, suffering abdominal sepsis in 2009 – 2019 yrs, excluding an acute cholecystitis cases, were analyzed. The patients were divided retrospectively and prospectively in accordance to the Sepsis–3 classification. Of them 130 have suffered peritoneal sepsis, 33 – intestinal one, and 38 – pancreatogenic abdominal. The results estimation was compared with application of modern systems: APACHE–II, Mannheim іndex of peritonitis (MPI), MODS and SOFA. The indices were estimated on the 1st, 2nd, 3rd and 4th postoperative days before subsequent outcomes of a primary operation.
Results. The prognosis systems with a square under the ROC–curve (AUC) > 0.8 have included MPI only for determination of indications for reoperations: the ROC–curves value for the first subgroup (the closed treatment) have constituted 0.73, for the second subgroup (reoperations in accordance to indications) – 0.91, and for the third – 0.84 (the programmed reoperations). But in the patients of first subgroup this index have constituted 0,73, indicating its application restricting the decision making process, concerning the reoperations efficacy in patients with absence of the septic shock signs.
Conclusion. Calculations of the occurrence possibility for postoperative complications and mortality in patients, depending on their preoperative state severity permits to select a most rational tactics of treatment. Most optimal approach for the rate reduction of postoperative complications occurrence and mortality in patients with abdominal sepsis and septic shock is performance of reoperations in accordance to indications to control the infection source, if it is possible. |
| first_indexed | 2024-04-09T15:58:59Z |
| format | Article |
| id | doaj.art-f2a990d5b3dc49f0a8a00e87fc31ff02 |
| institution | Directory Open Access Journal |
| issn | 0023-2130 2522-1396 |
| language | Russian |
| last_indexed | 2024-04-09T15:58:59Z |
| publishDate | 2020-05-01 |
| publisher | Liga-Inform ltd. |
| record_format | Article |
| series | Клінічна хірургія |
| spelling | doaj.art-f2a990d5b3dc49f0a8a00e87fc31ff022023-04-25T13:54:24ZrusLiga-Inform ltd.Клінічна хірургія0023-21302522-13962020-05-01871-2242910.26779/2522-1396.2020.1-2.24781Surgical treatment of patients with abdominal sepsis taking into account the prediction of the implementation of re-operationsI. A. Kryvoruchko0M. S. Antonova1O. V. Yevtushenko2S. A. Andreieshchev3Kharkiv National Medical UniversityKharkiv National Medical UniversityKharkiv National Medical UniversityShupyk National Medical Academy of Postgraduate Education, KyivObjective. The investigation objective was improvement of the surgical treatment results in patients, suffering аbdominal sepsis, using individualized tactics of treatment, taking into account a possibility for the postoperative complications occurrence and the treatment results prognostication. Маterials and methods. The results of treatment of the adult patients, suffering abdominal sepsis in 2009 – 2019 yrs, excluding an acute cholecystitis cases, were analyzed. The patients were divided retrospectively and prospectively in accordance to the Sepsis–3 classification. Of them 130 have suffered peritoneal sepsis, 33 – intestinal one, and 38 – pancreatogenic abdominal. The results estimation was compared with application of modern systems: APACHE–II, Mannheim іndex of peritonitis (MPI), MODS and SOFA. The indices were estimated on the 1st, 2nd, 3rd and 4th postoperative days before subsequent outcomes of a primary operation. Results. The prognosis systems with a square under the ROC–curve (AUC) > 0.8 have included MPI only for determination of indications for reoperations: the ROC–curves value for the first subgroup (the closed treatment) have constituted 0.73, for the second subgroup (reoperations in accordance to indications) – 0.91, and for the third – 0.84 (the programmed reoperations). But in the patients of first subgroup this index have constituted 0,73, indicating its application restricting the decision making process, concerning the reoperations efficacy in patients with absence of the septic shock signs. Conclusion. Calculations of the occurrence possibility for postoperative complications and mortality in patients, depending on their preoperative state severity permits to select a most rational tactics of treatment. Most optimal approach for the rate reduction of postoperative complications occurrence and mortality in patients with abdominal sepsis and septic shock is performance of reoperations in accordance to indications to control the infection source, if it is possible.https://hirurgiya.com.ua/index.php/journal/article/view/781аbdominal sepsis, stratification of risk, estimation of severity, investigations, surgery. |
| spellingShingle | I. A. Kryvoruchko M. S. Antonova O. V. Yevtushenko S. A. Andreieshchev Surgical treatment of patients with abdominal sepsis taking into account the prediction of the implementation of re-operations Клінічна хірургія аbdominal sepsis, stratification of risk, estimation of severity, investigations, surgery. |
| title | Surgical treatment of patients with abdominal sepsis taking into account the prediction of the implementation of re-operations |
| title_full | Surgical treatment of patients with abdominal sepsis taking into account the prediction of the implementation of re-operations |
| title_fullStr | Surgical treatment of patients with abdominal sepsis taking into account the prediction of the implementation of re-operations |
| title_full_unstemmed | Surgical treatment of patients with abdominal sepsis taking into account the prediction of the implementation of re-operations |
| title_short | Surgical treatment of patients with abdominal sepsis taking into account the prediction of the implementation of re-operations |
| title_sort | surgical treatment of patients with abdominal sepsis taking into account the prediction of the implementation of re operations |
| topic | аbdominal sepsis, stratification of risk, estimation of severity, investigations, surgery. |
| url | https://hirurgiya.com.ua/index.php/journal/article/view/781 |
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