Concordance of interrater assessments of surgical methods to achieve source control of intra-abdominal infections

Background Source control, any procedure used to control the source of a major infection, is critical to the resolution of intra-abdominal infections. We sought to characterize whether surgeons agree on methods of source control for patients who had persistent infection despite initial surgical treatment and antimicrobials. Methods We analyzed source control decisions in a trial comparing tigecycline with imipenem in the treatment of intra-abdominal infections for patients who were clinical failures and had persistent abdominal infections after treatment with antibiotics and undergoing source control. Results We found that source control agreement was least among patients who had Acute Physiology and Chronic Health Evaluation (APACHE) II scores greater than 15 (κ = −.17, P = .533) and those with complicated appendicitis (κ = .08, P = .446). There was excellent agreement in the source control decisions for perforation (κ = .76, P = 0.002) and diverticulitis (κ = 1.00, P = .005). Conclusions Agreement on source control is lacking on more severely ill patients and those with complicated appendicitis. These data should be used to seek optimal management for these conditions and to minimize variability in future clinical trials of intra-abdominal infection.