The impact of age and comorbidity on the postoperative outcomes after emergency surgical management of complicated intra-abdominal infections

Carmen Payá-Llorente,Nicola De’Angelis,Juan Carlos Sebastián-Tomás,Sandra Santarrufina-Martínez,Aleix Martínez-Pérez,Elías Martínez-López

doi:10.1038/s41598-020-58453-1

Abstract

Age-adjusted Charlson Comorbidity Index (a-CCI) score has been used to weight comorbid conditions in predicting adverse outcomes. A retrospective cohort study on adult patients diagnosed with complicated intra-abdominal infections (cIAI) requiring emergency surgery was conducted in order to elucidate the role of age and comorbidity in this scenario. Two main outcomes were evaluated: 90-day severe postoperative complications (grade ≥ 3 of Dindo-Clavien Classification), and 90-day all-cause mortality. 358 patients were analyzed. a-CCI score for each patient was calculated and then divided in two comorbid categories whether they were ≤ or > to percentile 75 ( = 4): Grade-A (0–4) and Grade-B ( ≥ 5). Univariate and multivariate regression analyses were performed, and the predictive validity of the models was evaluated by the area under the receiver operating characteristics (AUROC) curve. Independent predictors of 90-day severe postoperative complications were Charlson Grade-B (Odds Ratio [OR] = 3.49, 95% confidence interval [95%CI]: 1.86–6.52; p < 0.0001), healthcare-related infections (OR = 7.84, 95%CI: 3.99–15.39; p < 0.0001), diffuse peritonitis (OR = 2.64, 95%CI: 1.45–4.80; p < 0.01), and delay of surgery > 24 hours (OR = 2.28, 95%CI: 1.18–4.68; p < 0.02). The AUROC was 0.815 (95%CI: 0.758–0.872). Independent predictors of 90-day mortality were Charlson Grade-B (OR = 8.30, 95%CI: 3.58–19.21; p < 0.0001), healthcare-related infections (OR = 6.38, 95%CI: 2.72–14.95; p < 0.0001), sepsis status (OR = 3.98, 95%CI: 1.04–15.21; p < 0.04) and diffuse peritonitis (OR = 3.06, 95%CI: 1.29–7.27; p < 0.01). The AUROC for mortality was 0.887 (95%CI: 0.83–0.93). Post-hoc sensitivity analyses confirmed that the degree of comorbidity, estimated by using an age-adjusted score, has a critical impact on the postoperative course following emergency surgery for cIAI. Early assessment and management of patient’s comorbidity is mandatory at emergency setting.

Highlights

Complicated intra-abdominal infections are the second most common site of invasive infections in critically ill patients[1]
Out of 571 records of patients presenting with suspected or confirmed Complicated intra-abdominal infections (cIAI) in the study period, 367 (64%) patients diagnosed with cIAI at surgery and fulfilling the inclusion criteria were selected
The distribution of comorbid categories according to the a-Charlson Comorbidity Index (CCI) score was: Grade A 277 (77.4%), Grade B 81 (22.6%)

Summary

Introduction

Complicated intra-abdominal infections (cIAI) are the second most common site of invasive infections in critically ill patients[1]. A landmark multi-centric international prospective cohort study, evaluated adult patients presenting with cIAI undergoing surgery or interventional drainage and identified the independent risk factors of mortality[3]. They were namely patient’s age, immunosuppression, small bowel perforations, a delay of initial intervention over 24 hours, and intensive care unit (ICU) admission. The aim of the present study was to elucidate the role of the patient’s comorbidity adjusted by age[7], within other potential risk factors of postoperative adverse events, on the outcomes after emergency surgical procedures for cIAI treatment

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