Is patient factor more important than surgeon-related factor in sepsis prevention in colorectal surgery?
| Autor: | Elroy Patrick Weledji |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
medicine.medical_specialty
business.industry medicine.medical_treatment Peritonitis Immunosuppression Disease 030230 surgery medicine.disease Colorectal surgery Sepsis 03 medical and health sciences 0302 clinical medicine 030220 oncology & carcinogenesis Internal medicine Severity of illness medicine Surgery Complication business Cause of death |
| Zdroj: | International Journal of Surgery Open. 12:29-36 |
| ISSN: | 2405-8572 |
| DOI: | 10.1016/j.ijso.2018.07.001 |
| Popis: | Background Postoperative infection is an important complication of colorectal surgery and continued efforts are needed to minimize the risk of surgical site infection (SSI). Sepsis prevention in colorectal surgery depends upon the degree of contamination of the peritoneal cavity ( disease factor ), the preoperative status of the patient ( patient factor ) and surgical technique ( surgeon factor ). Immune response and metabolic regulation are highly integrated as minor operations may stimulate the immune response while the effect of major surgery is immunosuppression. The article debates the relative contributions and impact of patient and surgeon-related factors on sepsis prevention in colorectal surgery. Methods A retrospective literature review of published studies on sepsis prevention in colorectal surgery, bacteria-host interactions and the effects of immune deficiency, life-style (smoking, alcohol abuse) and non-steroidal anti-inflammatory drugs on the outcome of colorectal surgery. Results The most important factor in determining postoperative sepsis is the presence of viable organisms in the surgical field prior to wound closure. Inter-individual variation in the pattern of mediator release and of end-organ responsiveness may play a significant role in determining the initial physiological response to major sepsis and this in turn may be a key determinant of outcome. Sepsis source control failure in colorectal surgery are more likely in patients with delayed (>24 h) procedural intervention ( Patient/surgeon factor ), higher severity of illness - the Acute Physiology, Age and Chronic Health Care Evaluation score (APACHE >15 (patient/disease factor ), advanced age- >70yrs ( patient factor), co-morbidity ( patient factor) , poor nutritional status ( patient factor ) and a higher degree of peritoneal involvement – Mannheim peritonitis index (MPI) score ( disease factor) . It would be heralded by persistent or recurrent intra-abdominal infection, anastomotic failure or fistula formation. Conclusions The most important prognostic factors in emergency colorectal surgery are the preoperative status, age and faecal peritonitis. Thus, peritoneal sepsis is seldom the sole cause of death, but compounds coincidental cardiovascular, respiratory or renal pathology. The empiric choice of the surgical technique/procedure is predominantly determined by the patient status and the disease. The patient factor is thus more important than the surgeon factor in the prognosis of sepsis in emergency colorectal surgery but surgeon-related factors can influence the morbidity and mortality from sepsis in both elective and emergency colorectal surgery. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|