IMPACT OF EARLY (6H) SOURCE CONTROL ON MORBIDITY IN POSTOPERATIVE INTRA-ABDOMINAL SEPSIS: A PROSPECTIVE STUDY

Abstract

Intra-abdominal sepsis (IAS) postoperatively is a serious surgical complication with high morbidity and mortality. Source control in a timely manner is the standard of good management, but the best timing remains controversial. This prospective cohort study was designed to compare the effect of early (<6 hours) versus delayed (>6 hours) source control on clinical outcomes in patients with postoperative IAS. Sixty adult patients who developed IAS after abdominal surgery were included and allocated to early and delayed intervention groups. Baseline demographic and clinical factors were similar between groups, with the exception of a greater percentage of ASA ≥3 patients in the delayed group. The delayed source control group had much higher rates of major complications, such as Clavien-Dindo grade ≥III morbidity, surgical site infection, reoperation, anastomotic leak, and intra-abdominal abscess. The delayed intervention was also linked to longer ICU and hospital duration of stay, greater utilization of ventilator support, higher ICU readmission and hospital-acquired infection rates, and a marked deterioration in SOFA scores at 48 hours. Mortality outcomes were also significantly poorer in the delayed group, with higher in-hospital and 28-day mortality, greater failure-to-rescue rates, and lower recovery without significant morbidity. These results strongly favor the application of institutional guidelines prioritizing early source control within six hours of diagnosis in postoperative IAS to minimize morbidity, enhance survival, and maximize healthcare resource utilization.