Timing of surgical operation for patients with intra-abdominal infection: A systematic review and meta-analysis

Shu-Rui Song; Yang-Yang Liu; Yu-Ting Guan; Ruo-Jing Li; Lei Song; Jing Dong; Pei-Ge Wang

doi:10.4240/wjgs.v15.i10.2320

Timing of surgical operation for patients with intra-abdominal infection: A systematic review and meta-analysis

World J Gastrointest Surg. 2023 Oct 27;15(10):2320-2330. doi: 10.4240/wjgs.v15.i10.2320.

Authors

Shu-Rui Song¹, Yang-Yang Liu¹, Yu-Ting Guan¹, Ruo-Jing Li¹, Lei Song¹, Jing Dong², Pei-Ge Wang³

Affiliations

¹ Department of Emergency Surgery, The Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong Province, China.
² Medical Complex Building, Qingdao University, Qingdao 266071, Shandong Province, China.
³ Department of Emergency Surgery, The Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong Province, China. wpgzyz@163.com.

Abstract

Background: Intra-abdominal infections (IAIs) is the most common type of surgical infection, with high associated morbidity and mortality rates. In recent years, due to the use of antibiotics, various drug-resistant bacteria have emerged, making the treatment of abdominal infections more challenging. Early surgical exploration can reduce the mortality of patients with abdominal infection and the occurrence of complications. However, available evidence regarding the optimal timing of IAI surgery is still weak. In study, we compared the effects of operation time on patients with abdominal cavity infection and tried to confirm the best timing of surgery.

Aim: To assess the efficacy of early vs delayed surgical exploration in the treatment of IAI, in terms of overall mortality.

Methods: A systematic literature search was performed using PubMed, EMBASE, Cochrane Central Register of Controlled Trials, Ovid, and ScienceDirect. The systematic review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-analyses method. Based on the timing of the surgical operation, we divided the literature into two groups: Early surgery and delayed surgery. For the early and delayed surgery groups, the intervention was performed with and after 12 h of the initial surgical intervention, respectively. The main outcome measure was the mortality rate. The literature search was performed from May 5 to 20, 2021. We also searched the World Health Organization International Clinical Trials Registry Platform search portal and ClinicalTrials.gov on May 20, 2021, for ongoing trials. This study was registered with the International Prospective Register of Systematic Reviews.

Results: We identified nine eligible trial comparisons. Early surgical exploration of patients with IAIs (performed within 12 h) has significantly reduced the mortality and complications of patients, improved the survival rate, and shortened the hospital stay.

Conclusion: Early surgical exploration within 12 h may be more effective for the treatment of IAIs relative to a delayed operation.

Keywords: Infection; Intra-abdominal infection; Meta-analysis; Surgical exploration; Surgical operation; Systematic review; Timing.