Arreguín PJ, Torres VS

Language: Spanish
References: 19
Page: 7-13
PDF size: 69.33 Kb.

ABSTRACT

Objective: To demonstrate the usefulness of the APACHE II and POSSUM scoring systems and of the Manheim Peritonitis Index (MPI) in patients re-operated due to abdominal sepsis, with previous surgery due to abdominal oncological pathology performed with curative purposes.
Design: Prospective, comparative, longitudinal, observational study.
Statistical analysis. Chi square and Fisher’s exact tests.
Setting: Third level health care hospital.
Patients and methods: We assessed patients operated due to abdominal oncological pathology coursing with postoperative abdominal sepsis, diagnosed clinically and/or radiologically, in whom POSSUM, APACHE II, and MPI were measured during their stay in the intensive care unit.
Results: We studied 31 patients. Mortality was of 38.7%. Mortality in re-operated patients and men was of 47.3% and 66.6%, respectively (p = 0.002). Age ≥ 70 years, POSSUM › 25 for initial surgery, and APACHE II › 20 for the first re-intervention produced a mortality of 66%, 60%, and 80%, respectively (p = 0-001), MPI ≥ 24 and patients without drainage in the initial surgery were associated with re-operation in 80% (p = 0.002) and 88% (p = 0.001), respectively.
Conclusion: A high risk group for post-operative death can be established, which includes: Age › 70 years, male gender, re-operation, POSSUM › 25 at initial surgery, APACHE II › 20 at first re-operation. The group of high risk for a re-operation comprises those patients without drainage in the first surgery and MPI › 24.

REFERENCES

1. . Jones HJ, de Cossart L. Risk scoring in surgical patients. Br J Surg 1999; 86: 149-57.

2. Wisner DH. History and current status of scoring systems for critical care. Arch Surg 1992; 127: 352-6.

3. Chen FG, Khoo ST. Critical care medicine a review of the outcome prediction in critical care. Ann Acad Med Singapore 1993; 22: 360-4.

4. Knaus WA, Zimmerman JE, Wasner DP, Draper EA, Lawrence DE. APACHE-acute physiology and choronic health evaluation: a physiologically based classification system. Crit Care Med 1981; 9: 591-7.

5. Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med 1985; 13: 818-29.

6. Giangiuliani G, Mancini A, Gui D. Validation of a severity of illness score (APACHE II) in a surgical intensive care unit. Intensive Care Med 1989; 15: 519-22.

7. Bohnen JM, Mustard RA, Oxholm SE, Schouten BO. APACHE II score and abdominal sepsis. A prospective study. Arch Surg 1988; 123: 225-9.

8. Cerra FB, Negro F, Abrams J. APACHE II score does not predict multiple organ failure or mortality in postoperative surgical patients. Arch Surg 1990; 125: 519-22.

9. Lertakyamanee J, Somprakit P, Vorakitpokaton P, Kururattapan SA, Udompunturak S, Pensuk S. APACHE II in a postoperative intensive care unit in Thailand. J Med Assoc Thai 1997; 80: 169-77.

10. Vassar MJ, Wilkerson CL, Duran PJ, Perry CA, Holcroft JW. Comparison of APACHE II, TRISS and a proposed 24-hour ICU point system for prediction of outcome in ICU trauma patients. J Trauma 1992; 32: 490-499; discusion 499–500.

11. Bosscha K, Reindeers K, Hulstaert PF, Algra A, ven der Werken C. Prognostic scoring systems to predict outcome in peritonitis and intrabdominal sepsis. Br J Surg 1997; 84: 1532-4.

12. Wacha H. Mannheim Peritonitis Index-prediction of risk of death from peritonitis: construction of a statistical and validation of an empirically based index. Theor Surg 1987; 1: 16-77.

13. Knaus W, Wagner DP, Draper EA, Zimmernan JE, Bergner M, Bastos PG, et al. The APACHE III prognostic system. Risk prediction of hospital mortality for critically ill hospitalized adults. Chest 1991; 100: 1619-36.

14. Copeland GP, Jones D, Walters M. POSSUM: a scoring system for surgical audit. Br J Surg 1991; 78: 355-60.

15. Copeland GP, Sagar P, Brennan J, Roberts G, Ward J, Cornford P, et al. Risk-adjusted analysis of surgeon performance: a 1-year study. Br J Surg 1995; 82: 408-11.

16. Copeland GP, Jones D, Wilcox A, Harris PL. Comparative vascular audit using the POSSUM scoring system. Ann R Coll Surg Engl 1993; 75: 175-7.

17. Sagar PM. Hartley MN, Mancey-Jones B, Sedman PC, Mary J, Macfie J. Comparative audit of colorectal resection with the POSSUM scoring system. Br J Surg 1994; 81: 1492-4.

18. Whiteley MS, Prytherch DR, Higgins B, Weaver PC, Prout WF. An evaluation of the POSSUM surgical scoring system. Br J Surg 1996; 83: 812-5.

19. Jones DR, Copeland GP, de Cossart L. Comparison of POSSUM with APACHE II for prediction of outcome from a surgical high-dependency unit. Br J Surg 1992; 79: 1293-6.