Global Practice Habits In The Management Of Intra-abdominal Infections
*Richa Khatri, Robert Sawyer
Western Michigan University School of Medicine, Kalamazoo, MI
Objectives: Surgical infections remain a significant cause of worldwide morbidity, mortality, and healthcare cost burden. The World Surgical Infection Society (WSIS) was organized to help improve global outcomes from surgical infections. An initial project for WSIS is to assess how surgeons treat common intra-abdominal infections (IAI) in their regions.
Methods: A ten-item questionnaire was distributed electronically to members of four societies dedicated to the study of surgical infections: The Surgical Infection Society (SIS) North America, SIS Europe, SIS Latin America, and the Chinese Society of Surgical Infections. Questions were related to common treatment decisions in the management of IAI, such as peritoneal irrigation, fascial closure, appendiceal abscess, perforated viscus, etc. Responses were analyzed by comparing percentages with 95% confidence intervals.
Results: Globally, management was relatively similar for peritoneal irrigation (most commonly, with saline or other crystalloid- China 83.2% ± 5.8%, North America 93.2% ± 6.4%, Europe 85.7% ± 25.9%, and Latin America 71.8% ± 6.9%). More varied responses were seen for the management of specific disease states, such as for choledocholithiasis with cholangitis (ERCP followed by cholecystectomy: most common in North America, 83.1% ± 9.6%; and least common in China, 28.1% ± 7.0%), and for five-cm appendiceal abscess (percutaneous drainage and antibiotics: most common in North America, 93.2% ± 6.4%; and least common in Latin America, 19.6% ± 6.1%). Additionally, percentage of vacuum skin closure after fascial closure was fairly consistent between North America (32.2% ± 11.9%), Europe (28.6% ± 33.5%), and Latin America (27.6% ± 6.9%); however, was much lower in China (9.9% ± 4.4%), where there was higher rate of primary skin closure (85.7% ± 5.4%). Data on all ten questions will be presented.
Conclusion: Through its partnership with other surgical infection societies, WSIS aims to develop evidence-based guidelines for source control in the setting of IAI. This initial observational study into IAI management habits of surgeons globally may help elucidate where improvements can be made. Delving further into reasons why their practices differ, as well as analyzing their individual outcomes (rates of infection, antibiotic resistance, etc.), may help formulate solutions that are targeted to those regions.
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