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Prognostic Factors in Critically Ill Patients Suffering from Secondary Peritonitis: A Retrospective, Observational, Survival Time Analysis

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Abstract

Background

Acute mortality of unselected critically ill patients has improved during the last 15 years. Whether these benefits also affect survival of critically ill patients with secondary peritonitis is unclear as is the relevance of specific prognostic factors, such as source control.

Methods

We performed a retrospective analysis of data collected prospectively from March 1993 to February 2005. A cohort of 319 consecutive postoperative patients with secondary peritonitis requiring intensive care was evaluated. End points for outcome analysis were derived from daily changes of hazard rate.

Results

Four-month survival rate after intensive care unit (ICU) admission was 31.7%. For patients who have survived for more than 4 months, the 1-year survival was 82.7%. After adjustment for relevant covariates, a high disease severity at ICU admission and during ICU stay, specific comorbidities (extended malignancies, liver cirrhosis) and sources of infection (distal esophagus, stomach), and an inadequate initial antibiotic therapy were associated with worse 4-month prognosis. Inability to obtain source control was the most important determinant of mortality, and treatment after 2002 was combined with improved prognosis.

Conclusions

Four-month prognosis of critically ill, surgical patients with secondary peritonitis is poor and mostly determined by the ability to obtain source control. Outcome has improved since 2002, and after successful surgical and intensive care therapy long-term survival seems to be good.

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Acknowledgement

The authors thank D. Inthorn and H. Schneeberger for initiation and maintenance of the database.

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Authors and Affiliations

  1. Department of Surgery, Klinikum Grosshadern, Marchioninistr. 15, 81377, Munich, Germany

    Christian P. Schneider, Carol Seyboth, Markus Vilsmaier, Karl-Walter Jauch & Wolfgang H. Hartl

  2. Statistical Consulting Unit, Department of Statistics, Ludwig-Maximilian Universität München, Munich, Germany

    Helmut Küchenhoff & Benjamin Hofner

Authors
  1. Christian P. Schneider
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  2. Carol Seyboth
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  3. Markus Vilsmaier
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  4. Helmut Küchenhoff
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  5. Benjamin Hofner
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  6. Karl-Walter Jauch
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  7. Wolfgang H. Hartl
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Corresponding author

Correspondence to Wolfgang H. Hartl.

Additional information

C. P. Schneider and C. Seyboth contributed equally to this work.

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Schneider, C.P., Seyboth, C., Vilsmaier, M. et al. Prognostic Factors in Critically Ill Patients Suffering from Secondary Peritonitis: A Retrospective, Observational, Survival Time Analysis. World J Surg 33, 34–43 (2009). https://doi.org/10.1007/s00268-008-9805-4

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