Clinical Outcomes of Delayed Versus Immediate Source Control in Intra-Abdominal Sepsis Presenting to the Emergency Department: A Systematic Review

Authors

  • Mazi Mohammed Alanazi Emergency Medicine Consultant, Head of Emergency Research Unit, Emergency Department, Riyadh First Health Cluster, Riyadh, Saudi Arabia. ORCID: 0009-0003-5836-8086 Author
  • Najwa Ahmad M Alqurashi Saudi Board Emergency Medicine Resident, Emergency Department, Riyadh First Health Cluster, Riyadh, Saudi Arabia. ORCID: 0009-0008-2664-330X Author
  • Maram Mohammad Alawwad General Physician, College of Medicine, Vision College, Riyadh, Saudi Arabia. Author
  • Marah Asaad Murad Medical Intern, College of Medicine, Dar Al-Uloom University, Riyadh, Saudi Arabia Author
  • Naif Ayidh R Alaklabi General Physician, Primary Health Care, Riyadh First Health Cluster, Almuzahmia General Hospital, Riyadh, Saudi Arabia. Author
  • Seigha Mohammed AlShobai Gastroenterology Nurse, Member of the Research Committee, College of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia. Author

DOI:

https://doi.org/10.65759/bsw5h724

Keywords:

Intra-abdominal sepsis, intra-abdominal infection, source control, delayed source control, early intervention

Abstract

Background: The clinical impact of delayed source control in intra-abdominal sepsis is difficult to quantify because of heterogeneity in timing definitions, infection sources, and procedural approaches. This review evaluated delayed versus immediate or early source control mortality and other clinical outcomes in adults with intra-abdominal sepsis. Methods: PubMed, Scopus, Web of Science, and  Embase were searched from inception to January 2026. Eligible studies compared early with delayed operative, percutaneous, or endoscopic source control, or assessed time to intervention. Risk of bias was evaluated using ROBINS-I. Random-effects meta-analyses pooled odds ratios for mortality when studies were comparable. Results: Seven observational studies including 1,835 participants were included; three contributed to quantitative synthesis. Delayed drainage was associated with higher in-hospital mortality in the adjusted meta-analysis (pooled OR 2.92, 95% CI 1.51–5.66; I²=0%). In the harmonized comparison of source control after versus within 12 hours, the random-effects estimate was not significant (OR 1.92, 95% CI 0.44–8.39) and heterogeneity was substantial (I²=87.8%). Individual studies suggested worse outcomes with prolonged delay, although findings varied by source, threshold, and comparator.  Conclusion: Delayed source control increase mortality in biliary sepsis, but current evidence does not support a universal timing threshold. Prompt source control is clinically important, while better standardized prospective studies are needed.

References

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Published

2026-07-30

Issue

Vol. 3 No. 3 (2026): Journal of Tazeez for Public Health

Section

Articles