Impact of Early Surgical Debridement on Outcomes in ICU Patients With Sepsis-Associated Intra-Abdominal Infection: A Retrospective Analysis

AIM: To investigate the impact of early surgical debridement, defined as a diagnosis-to-knife time (D-to-K time) ≤12 hours, on intensive care unit (ICU) outcomes in patients with sepsis-associated intra-abdominal infection.METHODS: This single-center retrospective cohort study consecutively enrolled patients with sepsis-associated intra-abdominal infection who were admitted to the ICU and underwent surgical debridement between 1 January 2021 and 31 January 2025. Patients were stratified into an early surgery group (D-to-K time ≤12 hours, n = 65) and a delayed surgery group (D-to-K time >12 hours, n = 87). Baseline characteristics, ICU length of stay, duration of organ support, incidence of complications, mortality and other clinical outcomes were compared between the two groups. Multivariate logistic regression analysis was performed to evaluate the independent effect of early surgery on 28-day mortality.RESULTS: The delayed surgery group demonstrated a higher prevalence of preoperative septic shock (66.7% vs. 33.8%) and diffuse peritonitis (50.6% vs. 32.3%), as well as a higher proportion of open surgical procedures (90.8% vs. 76.9%) compared with the early surgery group. The early surgery group exhibited significantly shorter ICU length of stay, total duration of mechanical ventilation, and duration of vasoactive drug use. The incidences of ICU-acquired weakness (ICU-AW), acute kidney injury (AKI), and 28-day ICU mortality were significantly lower in the early surgery group. Surgical timing and preoperative septic shock were significantly associated with mortality. After adjustment for preoperative septic shock, early surgery remained an independent protective factor for 28-day mortality.CONCLUSIONS: In patients with sepsis-associated intra-abdominal infection, early surgical intervention (D-to-K time ≤12 hours) is associated with improved ICU outcomes, including shorter organ support duration, lower complication rates, and reduced 28-day mortality.