Abstract
Purpose: We developed a protocol to initiate surgical infectious source control immediately after admission (early infectious source control: EISC) and perform the initial resuscitation using early goal-directed therapy (EGDT) for gastrointestinal (GI) perforation with associated septic shock. This study evaluated the therapeutic effect of EISC in the protocol. Methods: This study involved 137 patients having GI perforation with associated septic shock. We examined the relationship between mortality and time to initiate surgery from admission (in 60 minutes periods) and determined the best cut-off time for a favorable 60-day outcome using receiver operating characteristic (ROC) analysis. We divided all patients into an EISC group, in which surgery started within the cut-off time, and a non-EISC group, in which it did not, and compared the outcomes and characteristics of the two groups. Results: ROC analysis selected 163 min as the best cut-off time for a favorable 60-day outcome (sensitivity: 0.62, specificity: 0.96). Also, the survival rate was 0% for times greater than 300 min. The EISC group comprised 69 cases and the non-EISC group comprised 68 cases when we divided the patients at the 163 minute mark. There were no significant differences between the two groups in patient background, severity, surgery or initial infusion volume. The outcomes for the EISC group were significantly better than those for the non-EISC group (60-day survival: 98% vs. 60%, p<0.0001). Conclusion: For patients having GI perforation with associated septic shock, EISC with support of hemodynamic stabilization by EGDT could improve the overall outcomes.
