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Critical Care
Published in: Critical Care 3/2014

Open Access 01-06-2014 | Research

Time from admission to initiation of surgery for source control is a critical determinant of survival in patients with gastrointestinal perforation with associated septic shock

Authors: Takeo Azuhata, Kosaku Kinoshita, Daisuke Kawano, Tomonori Komatsu, Atsushi Sakurai, Yasutaka Chiba, Katsuhisa Tanjho

Published in: Critical Care | Issue 3/2014

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Abstract

Introduction

We developed a protocol to initiate surgical source control immediately after admission (early source control) and perform initial resuscitation using early goal-directed therapy (EGDT) for gastrointestinal (GI) perforation with associated septic shock. This study evaluated the relationship between the time from admission to initiation of surgery and the outcome of the protocol.

Methods

This examination is a prospective observational study and involved 154 patients of GI perforation with associated septic shock. We statistically analyzed the relationship between time to initiation of surgery and 60-day outcome, examined the change in 60-day outcome associated with each 2 hour delay in surgery initiation and determined a target time for 60-day survival.

Results

Logistic regression analysis demonstrated that time to initiation of surgery (hours) was significantly associated with 60-day outcome (Odds ratio (OR), 0.31; 95% Confidence intervals (CI)), 0.19-0.45; P <0.0001). Time to initiation of surgery (hours) was selected as an independent factor for 60-day outcome in multiple logistic regression analysis (OR), 0.29; 95% CI, 0.16-0.47; P <0.0001). The survival rate fell as surgery initiation was delayed and was 0% for times greater than 6 hours.

Conclusions

For patients of GI perforation with associated septic shock, time from admission to initiation of surgery for source control is a critical determinant, under the condition of being supported by hemodynamic stabilization. The target time for a favorable outcome may be within 6 hours from admission. We should not delay in initiating EGDT-assisted surgery if patients are complicated with septic shock.
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Metadata
Title
Time from admission to initiation of surgery for source control is a critical determinant of survival in patients with gastrointestinal perforation with associated septic shock
Authors
Takeo Azuhata
Kosaku Kinoshita
Daisuke Kawano
Tomonori Komatsu
Atsushi Sakurai
Yasutaka Chiba
Katsuhisa Tanjho
Publication date
01-06-2014
Publisher
BioMed Central
Published in
Critical Care / Issue 3/2014
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/cc13854

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