Outcome in patients with open abdomen treatment for peritonitis: a multidomain approach outperforms single domain predictions

Abstract

Numerous patient-related clinical parameters and treatment-specific variables have been identified as causing or contributing to the severity of peritonitis. We postulated that a combination of clinical and surgical markers and scoring systems would outperform each of these predictors in isolation. To investigate this hypothesis, we developed a multivariable model to examine whether survival outcome can reliably be predicted in peritonitis patients treated with open abdomen. This single-center retrospective analysis used univariable and multivariable logistic regression modeling in combination with repeated random sub-sampling validation to examine the predictive capabilities of domain-specific predictors (i.e., demography, physiology, surgery). We analyzed data of 1,351 consecutive adult patients (55.7% male) who underwent open abdominal surgery in the study period (January 1998 to December 2018). Core variables included demographics, clinical scores, surgical indices and indicators of organ dysfunction, peritonitis index, incision type, fascia closure, wound healing, and fascial dehiscence. Postoperative complications were also added when available. A multidomain peritonitis prediction model (MPPM) was constructed to bridge the mortality predictions from individual domains (demographic, physiological and surgical). The MPPM is based on data of n = 597 patients, features high predictive capabilities (area under the receiver operating curve: 0.87 (0.85 to 0.90, 95% CI)) and is well calibrated. The surgical predictor “skin closure” was found to be the most important predictor of survival in our cohort, closely followed by the two physiological predictors SAPS-II and MPI. Marginal effects plots highlight the effect of individual outcomes on the prediction of survival outcome in patients undergoing staged laparotomies for treatment of peritonitis. Although most single indices exhibited moderate performance, we observed that the predictive performance was markedly increased when an integrative prediction model was applied. Our proposed MPPM integrative prediction model may outperform the predictive power of current models.

Outcome of Acute Peritonitis Related To Cause and Duration Of Presentation

“…Similarly, mortality was more in this study for the patients who presented late. 16 Early surgical intervention can prevent various surgical complications like paralytic ileus, although prompt treatment, appropriate and adequate administration of fluids can also minimize this complication. Instilling proper surgical techniques, washing the abdominal cavity with adequate fluid, minimizing the use of gauze, and surgical drains can prevent complications like wound infections, burst abdomen, intra-adhesional collection, and postoperative collection, abscess, and adhesions.…”

Closed-Loop Bowel Obstruction Years After an Open Abdominal Aortic Aneurysm Repair

“…In an unstable patient with peritonitis, emergent operative intervention is required [7]. In hemodynamically stable patients, computed tomography with intravenous contrast is a valuable diagnostic tool.…”

Biomarkers and Cellular Biology in Perioperative Medicine

“…However, individual treatments cannot be standardized, and the integration of individual genetic and multi-omics information bears an enormous potential to further improve the quality of perioperative outcomes [ 11 ]. In addition, integrating biomarkers, cellular biology, and clinical data offers tremendous possibilities in our journey toward comprehensive perioperative organ protection [ 12 ] and improvement of traditional risk prediction models [ 4 , 5 , 6 , 13 ]. As an extra level of complexity, some biomarkers, such as lipoprotein(a), can predict risk with high sensitivity and specificity for some outcomes, but the same markers’ predictive power fades in other endpoints [ 14 , 15 ].…”