LAPAROTOMY FOR ABDOMINAL SEPSIS IN THE CRITICALLY ILL

Among 125 patients admitted to an intensive care unit (ICU) with sever e abdominal sepsis over a 3-year period, further laparotomy was requir ed in 60 (48 per cent). The median age of these 60 patients was 67 (ra nge 22-88) years and their admission APACHE (Acute Physiology and Chro nic Health Evaluation) II score was 24 (range 7-40); 25 patients (42 p er cent) survived to leave the ICU but only 19 (32 per cent) survived to leave hospital. These patients underwent 95 (median 1; range 1-6) o perations after admission to the ICU and survival fell with increasing number of operations in the ICU (P = 0.01). A total of 81 operations (85 per cent) were therapeutic in that pus was drained or dead tissue removed, and 41 operations (43 per cent) resulted in improvement in th e patient's condition within 48 h of surgery. Only nine per cent of pa tients not improved by their first operation in the ICU survived (P < 0.0001). The source of sepsis was eradicated from the abdomen in 37 pa tients (62 per cent); this was a prerequisite for survival but was ach ieved less frequently with increasing number of operations (P < 0.002) . When operations were delayed until the diagnosis was clear, the need for subsequent procedures was significantly increased (P < 0.05). Mul tiple operations for patients with abdominal sepsis in the ICU were as sociated with diminishing returns and alternative surgical strategies merit active consideration.