Multiorgan Failure Post-Abdominal Surgery: A Systematic Review of Trends and Clinical Outcomes

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It often follows a Major Abdominal Surgery (MAS). Even with improved surgical care, it remains a leading cause of ICU related deaths. Its pathophysiology is still not clearly understood and data on management is limited. Objective This systematic review aims to analyze trends and clinical outcomes of multiple organ failure following a major abdominal surgery. Methods A comprehensive literature search was conducted using SCOPUS, Web of Science and MEDLINE (via PubMed) to identify studies on multiple organ failure following a major abdominal surgery. Results The study reviewed 14 articles involving 8,267 patients and found a 19.27% incidence of MODS. The systems mainly affected were the liver, circulatory, coagulation and pulmonary systems. Mortality was 3.5%, influenced by disease severity and organ involvement. Conclusion Multiple Organ Dysfunction Syndrome (MODS) remains an important concern following major abdominal surgery. This review shows age, gender, and organ involvement as key factors in its development. Early detection using scoring systems have been found to be crucial for management. However, variability in studies limits generalizability, requiring further research. Multiple Organ Dysfunction Syndrome (MODS) Major Abdominal Surgery Perioperative Complications Systemic Inflammatory Response Figures Figure 1 1.0 Introduction Multiple Organ Failure Syndrome also known as Multiple Organ Dysfunction Syndrome (MODS) is explained as a continuing failure of multiple organ systems, where it is challenging to maintain homeostasis without medical intervention [ 1 ]. It is the primary cause of mortality among the high-risk cases of trauma and surgery, who have survived the initial 24 hours, contributing to nearly half of all ICU deaths [ 2 ]. The condition is particularly challenging to manage due to its rapid escalation, often outpacing medical intervention [ 3 ]. At its core, MODS arises from an exaggerated systemic inflammatory response to acute insults such as trauma or infection, which frequently precede or follow major surgical procedures, further complicating patient outcomes. With advancements in disease management, the number of surgical procedures performed worldwide continues to rise. However, hemodynamic instability remains a common intraoperative challenge, often leading to severe perioperative complications or even death [ 4 , 5 ]. Although high-risk surgeries account for only a small fraction of all procedures, they are responsible for the majority of surgery-related deaths [ 6 ]. Among these, major abdominal surgeries are particularly significant, as the lifetime risk of undergoing such a procedure exceeds 40% [ 7 ]. In the United States alone, nearly 10 million open abdominal surgeries were performed over a span of 4 years [ 8 ], highlighting both the prevalence and the potential for severe complications associated with these procedures. ‘Major Abdominal Surgery’ (MAS) can be described as an operation primarily within the peritoneal cavity with no major thoracic involvement, it can involve either a lumen-based resection and/or a solid organ resection of the digestive system [ 9 ]. MAS and its peri-operative complications are known to have a significant impact on the patient's physical, biochemical, physiological and socio-economic function and also affect their mental health [ 10 , 11 , 12 ]. As a result, it creates a convenient environment for the development of complications like MODS. Despite decades of research, the pathophysiology of MODS remains poorly understood, with inconsistent data on the mechanisms driving organ dysfunction in critically ill patients [ 13 ]. While conventional causes are well recognized, additional factors such as intraoperative organ hypoperfusion [ 14 ], mitochondrial dysfunction [ 15 ] and abdominal compartment syndrome [ 16 ] have also been implicated. Further complicating the condition, organ cross-talk mediated by molecular signaling amplifies its systemic nature, emphasizing the intricate interconnections between organ systems [ 17 , 18 ]. Given its complexity, management remains multimodal and multidisciplinary, focusing primarily on supportive care. Early detection, timely ICU admission, and invasive organ support play a crucial role in improving patient outcomes [ 19 ]. This review aims to evaluate the trends and clinical outcomes of multiple organ failure syndrome following major abdominal surgery. It examines patient demographics, incidence, organ involvement and mortality while discussing implications for clinical practice based on the findings. 2.0 Methods and Materials A systematic review has been conducted following the Preferred Reporting items for SR and MA (PRISMA) 2020 guidelines ensuring transparency and rigor. Search strategy : A comprehensive literature search was done in 3 electronic databases which are SCOPUS, web of science, MEDLINE (via PubMed). The search strategy was limited to articles that were published in English in the last 10 years. A few revealing studies were identified through a manual search of the references of some key studies. The terms were carefully selected from the 2014–2024 studies these keywords include: Multiorgan Dysfunction Syndrome, Multiple Organs Failures, MODS, Multiple Organ Dysfunction Syndrome, Major abdominal surgery, point prevalence, Period prevalence, predisposing factors, enabling factors, participating factors, reinforcing factors, causalities and causations. The collected references, including those from the grey literature, were imported into Rayyan software for deduplication. Following this, the references were screened based on the established inclusion and exclusion criteria (Table 1 ). Study selection process : Two reviewers independently performed the study selection process using Rayyan software. First, all titles and abstracts were recorded and assessed to exclude studies that did not meet the inclusion criteria. Then, full-text articles were obtained and reviewed by the reviewers to determine final eligibility. Finally, in the event of disagreements between reviewer decisions, conflicts were flagged for further discussion. The two reviewers initially discussed to understand each other's reasoning, then a third impartial reviewer was brought in to facilitate discussion and reach a consensus. If necessary, the third reviewer made the final decision based on the inclusion/exclusion criteria and the study's relevance. The study selection process was documented using the PRISMA flow diagram. (Fig. 1 ) Data extraction : It was done using a standardized spreadsheet. Two independent reviewers performed data extraction from each included study, covering essential aspects such as: sample, patient demographics, type of surgery, prevalence/incidence, organs involved, and outcomes. Discrepancies in extraction were resolved by the reviewers after discussion. Data analysis Firstly, the analysis was done using Google sheet and X Miner extension for age distribution., and then age distribution was analyzed with a 95% confidence level. Next the results showed age distribution of multi organ failure syndrome, the number of multi organ failure syndrome per surgery and the differences in incidence and prevalence by type of surgery. 3.0 Results Screening and Study Selection: A total of 1,332 records were obtained following initial search, of which 732 records were screened for inclusion following removal of duplicates. 22 records were further evaluated via a full-text screening, of which 14 were finally included for further qualitative synthesis [1-14]. A detailed PRISMA chart is provided in Figure 1. Study characteristics: Fourteen records with a total sample size of 8,267 patients were considered for qualitative analysis. These consisted of 11 cohort studies, 2 case-control studies, and one randomized controlled trial. These studies were published within the recent decade, ranging from 2016 to 2023. Records were mainly conducted in Europe and the USA, with few studies in China, Japan, and India. Baseline characteristics: The study population comprised patients aged from 39 to 70 years old. Males formed a higher percentage of the population (n=4115, 49.78%). The type of surgery included pancreatectomy in 7 studies, cholecystectomy in 2 studies, and other procedures like esophagectomy. Quality assessment: Quality assessment was performed using the NOS tool. Studies with a total score of 7 or more were considered to be “high” quality, while those below 7 were considered to be “poor” quality due to biases. Nine studies were deemed to be of high quality, while five studies were considered to be of poor quality, due to biasing in comparability between cohorts. Detailed quality assessment is provided in Table 1. Outcomes: The incidence of MFS among the patient population was 1,630 out of 8,267 patients (19.72%). The main organs involved include the liver, followed by the circulatory and coagulation system, and pulmonary complications. Sepsis and multi-organ dysfunction were reported in three studies. Of these patients, 57 (3.5%) died due to complications. A few reported complications include severe pancreatic necrosis, pancreatic fistula, chylothorax, and intra-abdominal infections. A summary of the findings from the 14 included articles is provided by table 2,3,4 and 5 below. 4.0 Discussion Age This study found that the mean age of patients affected by MODS after major abdominal surgery (MAS) was 57.6 (SE 2.7), which aligns with findings from other similar studies. For instance, a study examining the incidence of MODS following emergency non-cardiac admissions reported a mean age of 58.8 [ 33 ]. Another study focusing on MODS after polytrauma found a mean age of 48, with an observed increase in age over the 10-year study period, attributed to the aging population in Australia [ 34 ]. Notably, MODS patients were generally older than non-MODS patients admitted for polytrauma. However, a study analyzing risk factors for MODS caused by sepsis found no significant age difference between MODS and non-MODS groups [ 35 ]. Older age has been associated with longer ICU stays and increased ventilator use, contributing to higher morbidity and greater resource utilization [ 34 ]. Age, particularly over 50 years, is recognized as an independent risk factor for MODS across various scoring systems [ 36 ] and is also a predictor of mortality [ 37 ]. While the exact mechanisms remain unclear, potential factors include reduced physiologic reserve, the presence of comorbid conditions that impair the body’s response to injury, polypharmacy common in older adults, and other unidentified factors [ 37 ]. Gender Among the 14 studies reviewed, 12 reported a higher prevalence of MODS in males, consistent with findings from other studies in different contexts. For example, Jansson et al. found that 62.5% of MODS patients were male [ 33 ], while King et al reported that 81% of MODS patients following polytrauma were male, a proportion higher than that observed in non-MODS patients [ 38 ]. Similarly, in post-sepsis MODS, males were found to have twice the likelihood of developing MODS compared to females. Males also tend to exhibit higher SOFA organ dysfunction scores, which may contribute to greater disease severity [ 39 ]. This could be linked to higher levels of proinflammatory cytokines such as IL-6 in males, which may play a role in the pathophysiology of MODS [ 27 ]. Angele et al suggest that hormonal differences between genders may influence immune responses, with male hormones potentially exacerbating inflammation and female hormones offering protective effects, possibly explaining better outcomes in females [ 40 ]. However, the relationship between gender and MODS incidence is complex. Incidence The review found that the incidence of MODS among the studied patient population was 1,630 out of 8,267 patients, representing 19.72% of the sample. In a study examining MODS in trauma patients in Australia, the incidence was 2% of trauma patients, equivalent to 0.8 cases per 100,000 people. Among patients classified as at-risk for MODS, the incidence rose to 23% [ 41 ]. Another study reported that 21% of post-injury patients at a trauma center developed MODS [ 38 ]. A UK-based study found that the incidence of MODS in trauma patients within 24 hours was as high as 55%, translating to approximately 3,300 patients annually and 33,000 critical care bed days [ 42 ]. Organ system involved The most commonly affected organ systems in this study were the liver, followed by the circulatory, coagulation, and pulmonary systems, consistent with findings in other studies of MODS. Another study reported that cardiac and respiratory failures were the most prevalent in post-injury patients, though these were associated with lower mortality compared to renal and hepatic failures (37%, 23%, 63%, and 50%, respectively) [ 41 ]. Respiratory failure was linked to longer hospital stays, and it has been suggested that MODS progression often depends on respiratory failure as a catalyst. Renal and hepatic failures typically occur later in the disease course, which may explain their association with higher mortality [ 41 ]. Cole et al similarly found that respiratory and cardiovascular dysfunctions were the primary contributors to MODS (97% and 91%, respectively), followed by central nervous system involvement [ 42 ]. Recent studies have shown increased involvement of these systems compared to older studies, possibly due to the respiratory system’s susceptibility to inflammatory responses [ 43 ]. The cardiovascular system plays a critical role in MODS progression, as derangements in cardiovascular parameters can lead to hypoxia and hypoperfusion, contributing to the failure of other organs [ 44 ]. Patients with extreme organ dysfunction, particularly involving the renal and hepatic systems, often require more intensive ICU support [ 45 ]. Mortality This study reported a mortality rate of 3.5% among the selected patient population, which is lower than mortality rates associated with MODS due to other surgical-related causes. Ting found that mortality among MODS patients following trauma ranged between 6% and 17% across different trauma centers [ 41 ]. Jansson et al. reported that mortality in MODS patients varied by care setting, with rates of 7.2% in the ICU overall and 12.4% in the hospital [ 33 ]. However, the highest mortality rate (40.1%) was observed in patients admitted to the ICU from the emergency department, underscoring the importance of early recognition and management of organ failure [ 33 ]. King et al. noted that polytrauma patients with MODS had higher mortality rates than their non-MODS counterparts, with mortality increasing with age [ 38 ]. Mortality in MODS patients is influenced by multiple factors, including disease severity as measured by scoring systems such as APACHE II and SOFA, which are independent risk factors for death in patients with post-traumatic sepsis [ 46 ]. The number of organs involved is another critical determinant, with involvement of three or more organs associated with a mortality rate of 70%, highlighting the challenges in managing this condition [ 19 ]. Implications for clinical practice The study highlights several important aspects that have to be emphasized in the management of MODS post-abdominal surgery. First, monitoring and early detection of signs of decline in such high-risk patients is key due to the risk of exacerbation of comorbidities and progression of MODS. Clinical scoring systems such as SOFA and APACHE II should be integrated early into patient assessments to allow for clinicians to track progression of this condition. This in turn will enable early and targeted interventions for high-risk patients. Patients in the emergency departments are at higher risk of mortality due to MODS especially due to failures in detection and early management. For this reason, a high index of suspicion should be maintained in patients presenting with signs of systemic inflammation and organ dysfunction. Diagnostic and therapeutic measures can then be implemented in a timely manner which will optimize outcomes. This study highlighted the vulnerability of the cardiovascular and respiratory systems early in the disease course of MODS as they are more likely to fail first. They thus require aggressive support through hemodynamic stabilization, adequate oxygenation, and ventilation to prevent further damage. In patients with prolonged stays in ICU, monitoring of their hepatic and renal systems gets more priority as they are vulnerable to secondary injuries later in the disease course and can influence clinical outcomes. Integration of risk stratification scores such as SOFA and APACHE II into clinical workflows has also been emphasized. These scores give an objective method for assessing disease severity and influencing aspects of therapy. They can also give an aid to communicating prognosis to patients and their families. The standardized nature of the scores allows comparisons between different clinical settings. On this note, there is a need for integration of these scores internationally to further streamline comparisons in different contexts. In summary, the findings of this study call for a proactive, systematic approach to the management of MODS, with an emphasis on early detection, aggressive organ support, and the integration of validated scoring systems into routine clinical practice. By adopting these strategies, healthcare providers can improve patient outcomes, reduce mortality, and enhance the overall quality of care for individuals at risk of MODS. 5.0 Limitations This systematic review, despite providing valuable insights into MODS, has several limitations. The quality of findings of this paper depends on the rigor of the included articles. In addition, the articles have used different definitions of MODS which introduces bias into the findings. Heterogeneity of the patient populations and surgical procedures included for analysis limits generalizability of these results. In addition, there is a possibility of publication bias as inconclusive studies may have been excluded for analysis. Studies not published in English were excluded, and a search of gray literature was not done, further limiting the scope of the review. A few of the studies were conducted many years ago and the standard of practice then may not be reflective of what is done now. Since the review synthesizes observational data, causative relationships between MODS and abdominal surgery cannot be derived. Finally, the included studies were done in diverse health systems with different practices and resources which limits generalizability of these results. 6.0 Conclusion In critically sick patients, especially those after major abdominal surgery, Multiple Organ Dysfunction Syndrome (MODS) continues to be a significant concern. Organ cross-talk, systemic inflammatory responses, and other perioperative problems interact intricately to create this complicated disease. The exact pathophysiology of MODS is still unclear after decades of research, hence further study into its causes is required. Even though they make up a smaller portion of all surgeries, high-risk surgical procedures have a major impact on the morbidity and mortality associated with surgery. To reduce the incidence of MODS, this emphasizes the significance of early detection, efficient perioperative care, and focused therapies. Results have been somewhat enhanced by developments in organ support systems, hemodynamic monitoring, and surgical methods. Innovative therapy strategies, such as fecal microbiota transplantation, gut microbiota targeting, and molecular mediators implicated in MODS development, are desperately needed. The frequency, risk factors, and treatment approaches for MODS after major abdominal surgery are highlighted in this study. In order to enhance patient outcomes, it highlights the significance of preventative efforts and the necessity of interdisciplinary teamwork. In order to lessen the burden of MODS in surgical and trauma patients, it also promotes investigating new treatments and improving long-term care strategies. To further address the problems of this life-threatening illness, future research should concentrate on discovering biomarkers for early identification, enhancing perioperative treatment, and figuring out the molecular processes behind organ malfunction. Declarations Conflict of interest: The Authors declare no conflicts of interest Funding: No funding was available for this study Author contributions: Initial Idea: M.A.Y and F.H Literature search: A.M.K, V.I, M.G Writing article: M.A.Y, A.M.K, N.P.E, V.I, S.T.B.S.S, M.I, N.G.O.A, S.R, J.G.T Final Approval: F.H, M.A.Y, A.M.K Copyright and Publishing Agreement By submitting this manuscript to Digestive Diseases and Sciences Journal, all authors agree to transfer copyright of the published work to the journal. The authors affirm that this manuscript is original, has not been published elsewhere, and is not under consideration by any other journal. References Nickson DC. Multiple Organ Dysfunction Syndrome • Life In The Fast Lane.2019. https://litfl.com/multiple-organ-dysfunction-syndrome/ Barie PS, Hydo LJ, Pieracci FM, Shou J, Eachempati S. Multiple organ dysfunction syndrome in critical surgical illness. Surg Infect. 2009;10(5):369–377. doi: 10.1089/sur.2009.9935 Wang H, Ma S. 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The multiple organ dysfunction syndrome. https://www.ncbi.nlm.nih.gov/books/NBK6868/ Eriksson J, Nelson D, Holst A, Hellgren E, Friman O, Oldner A. Temporal patterns of organ dysfunction after severe trauma. Crit Care. 2021;5;25(1):165. Tong Y, Zhang J, Fu Y, He X, Feng Q. Risk factors and outcome of sepsis in traumatic patients and pathogen detection using metagenomic next-generation sequencing. Can J Infect Microbiol Médicale. Published online 2022. Tables Tables 1 to 8 are available in the Supplementary Files section Additional Declarations No competing interests reported. Supplementary Files Tables.docx searchstringMultiorganFailureSyndrome.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Henna","email":"","orcid":"","institution":"Dubai Medical College for Girls","correspondingAuthor":false,"prefix":"","firstName":"Fathimathul","middleName":"","lastName":"Henna","suffix":""},{"id":428655706,"identity":"0751e270-39f2-46f7-92d5-dd1741c492ff","order_by":2,"name":"Alex Mwangi Kihunyu","email":"data:image/png;base64,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","orcid":"","institution":"University of Nairobi","correspondingAuthor":true,"prefix":"","firstName":"Alex","middleName":"Mwangi","lastName":"Kihunyu","suffix":""},{"id":428655707,"identity":"cfcb66e9-c016-4378-924c-f507c3803a7e","order_by":3,"name":"Nsangou Paul Eric","email":"","orcid":"","institution":"Université des montagnes","correspondingAuthor":false,"prefix":"","firstName":"Nsangou","middleName":"Paul","lastName":"Eric","suffix":""},{"id":428655708,"identity":"b1364981-26c4-4986-98ef-4c44af292699","order_by":4,"name":"Mobin Ghaderi","email":"","orcid":"","institution":"Kurdistan University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Mobin","middleName":"","lastName":"Ghaderi","suffix":""},{"id":428655709,"identity":"84ac4af2-0e06-4b4c-a6de-61c67e6a68c9","order_by":5,"name":"Vernon Ipomai","email":"","orcid":"","institution":"University of Nairobi","correspondingAuthor":false,"prefix":"","firstName":"Vernon","middleName":"","lastName":"Ipomai","suffix":""},{"id":428655710,"identity":"8de319ca-8203-4a10-8e3f-44bb90d0cfb2","order_by":6,"name":"Shams Tabrez Bin Salam Shaikh","email":"","orcid":"","institution":"Siddhartha Medical College","correspondingAuthor":false,"prefix":"","firstName":"Shams","middleName":"Tabrez Bin Salam","lastName":"Shaikh","suffix":""},{"id":428655711,"identity":"038f8b89-1ce3-4e43-9669-e917b999ebdd","order_by":7,"name":"Mehmoona Irshad","email":"","orcid":"","institution":"University of Health Sciences Lahore","correspondingAuthor":false,"prefix":"","firstName":"Mehmoona","middleName":"","lastName":"Irshad","suffix":""},{"id":428655712,"identity":"a9707495-e072-4ec1-9f8f-a4db502a9276","order_by":8,"name":"Nanaakua Gyamea Osei Akoto","email":"","orcid":"","institution":"Kwame Nkrumah University of Science and Technology","correspondingAuthor":false,"prefix":"","firstName":"Nanaakua","middleName":"Gyamea Osei","lastName":"Akoto","suffix":""},{"id":428655713,"identity":"a6356911-9719-4b92-a735-b7d8c0d1c6d8","order_by":9,"name":"Shree Rath","email":"","orcid":"","institution":"All India Institute of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Shree","middleName":"","lastName":"Rath","suffix":""},{"id":428655714,"identity":"017169a0-7d44-43cc-8a9d-6b7911a0e520","order_by":10,"name":"Jessica Guiegang Tigui","email":"","orcid":"","institution":"UFR of Medical Sciences of Abidjan","correspondingAuthor":false,"prefix":"","firstName":"Jessica","middleName":"Guiegang","lastName":"Tigui","suffix":""}],"badges":[],"createdAt":"2025-03-09 07:38:07","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6187343/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6187343/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":78732013,"identity":"a08b0b61-c544-4f59-bbfd-6f6ee4ce9715","added_by":"auto","created_at":"2025-03-18 07:42:46","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":155200,"visible":true,"origin":"","legend":"\u003cp\u003ePRISMA flowchart\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6187343/v1/fba3a0ce1f706cd531a82407.png"},{"id":78734291,"identity":"645d4422-d017-4f06-816a-acc3e835de99","added_by":"auto","created_at":"2025-03-18 07:58:51","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":766516,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6187343/v1/501cf91b-66e1-4066-909d-06e5ce3cd3aa.pdf"},{"id":78732007,"identity":"0d83be59-5a0e-4096-bda9-c3d5430399f0","added_by":"auto","created_at":"2025-03-18 07:42:46","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":189864,"visible":true,"origin":"","legend":"","description":"","filename":"Tables.docx","url":"https://assets-eu.researchsquare.com/files/rs-6187343/v1/606c1bddbf5c87edbc8cb8bf.docx"},{"id":78732012,"identity":"6ba12e73-35a9-42b2-ba6f-15454326bce0","added_by":"auto","created_at":"2025-03-18 07:42:46","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":14968,"visible":true,"origin":"","legend":"","description":"","filename":"searchstringMultiorganFailureSyndrome.docx","url":"https://assets-eu.researchsquare.com/files/rs-6187343/v1/2964459f96c6e3250ea8f211.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Multiorgan Failure Post-Abdominal Surgery: A Systematic Review of Trends and Clinical Outcomes","fulltext":[{"header":"1.0 Introduction","content":"\u003cp\u003eMultiple Organ Failure Syndrome also known as Multiple Organ Dysfunction Syndrome (MODS) is explained as a continuing failure of multiple organ systems, where it is challenging to maintain homeostasis without medical intervention [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. It is the primary cause of mortality among the high-risk cases of trauma and surgery, who have survived the initial 24 hours, contributing to nearly half of all ICU deaths [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. The condition is particularly challenging to manage due to its rapid escalation, often outpacing medical intervention [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. At its core, MODS arises from an exaggerated systemic inflammatory response to acute insults such as trauma or infection, which frequently precede or follow major surgical procedures, further complicating patient outcomes.\u003c/p\u003e \u003cp\u003eWith advancements in disease management, the number of surgical procedures performed worldwide continues to rise. However, hemodynamic instability remains a common intraoperative challenge, often leading to severe perioperative complications or even death [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Although high-risk surgeries account for only a small fraction of all procedures, they are responsible for the majority of surgery-related deaths [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Among these, major abdominal surgeries are particularly significant, as the lifetime risk of undergoing such a procedure exceeds 40% [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. In the United States alone, nearly 10\u0026nbsp;million open abdominal surgeries were performed over a span of 4 years [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], highlighting both the prevalence and the potential for severe complications associated with these procedures.\u003c/p\u003e \u003cp\u003e\u0026lsquo;Major Abdominal Surgery\u0026rsquo; (MAS) can be described as an operation primarily within the peritoneal cavity with no major thoracic involvement, it can involve either a lumen-based resection and/or a solid organ resection of the digestive system [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. MAS and its peri-operative complications are known to have a significant impact on the patient's physical, biochemical, physiological and socio-economic function and also affect their mental health [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. As a result, it creates a convenient environment for the development of complications like MODS.\u003c/p\u003e \u003cp\u003eDespite decades of research, the pathophysiology of MODS remains poorly understood, with inconsistent data on the mechanisms driving organ dysfunction in critically ill patients [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. While conventional causes are well recognized, additional factors such as intraoperative organ hypoperfusion [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e], mitochondrial dysfunction [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] and abdominal compartment syndrome [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e] have also been implicated. Further complicating the condition, organ cross-talk mediated by molecular signaling amplifies its systemic nature, emphasizing the intricate interconnections between organ systems [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Given its complexity, management remains multimodal and multidisciplinary, focusing primarily on supportive care. Early detection, timely ICU admission, and invasive organ support play a crucial role in improving patient outcomes [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThis review aims to evaluate the trends and clinical outcomes of multiple organ failure syndrome following major abdominal surgery. It examines patient demographics, incidence, organ involvement and mortality while discussing implications for clinical practice based on the findings.\u003c/p\u003e"},{"header":"2.0 Methods and Materials","content":"\u003cp\u003eA systematic review has been conducted following the Preferred Reporting items for SR and MA (PRISMA) 2020 guidelines ensuring transparency and rigor.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSearch strategy\u003c/strong\u003e:\u003c/p\u003e\n\u003cp\u003eA comprehensive literature search was done in 3 electronic databases which are SCOPUS, web of science, MEDLINE (via PubMed). The search strategy was limited to articles that were published in English in the last 10 years. A few revealing studies were identified through a manual search of the references of some key studies. The terms were carefully selected from the 2014\u0026ndash;2024 studies these keywords include: Multiorgan Dysfunction Syndrome, Multiple Organs Failures, MODS, Multiple Organ Dysfunction Syndrome, Major abdominal surgery, point prevalence, Period prevalence, predisposing factors, enabling factors, participating factors, reinforcing factors, causalities and causations. The collected references, including those from the grey literature, were imported into Rayyan software for deduplication. Following this, the references were screened based on the established inclusion and exclusion criteria (Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy selection process\u003c/strong\u003e:\u003c/p\u003e\n\u003cp\u003eTwo reviewers independently performed the study selection process using Rayyan software. First, all titles and abstracts were recorded and assessed to exclude studies that did not meet the inclusion criteria. Then, full-text articles were obtained and reviewed by the reviewers to determine final eligibility. Finally, in the event of disagreements between reviewer decisions, conflicts were flagged for further discussion. The two reviewers initially discussed to understand each other\u0026apos;s reasoning, then a third impartial reviewer was brought in to facilitate discussion and reach a consensus. If necessary, the third reviewer made the final decision based on the inclusion/exclusion criteria and the study\u0026apos;s relevance.\u003c/p\u003e\n\u003cp\u003eThe study selection process was documented using the PRISMA flow diagram. (Fig. \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData extraction\u003c/strong\u003e:\u003c/p\u003e\n\u003cp\u003eIt was done using a standardized spreadsheet. Two independent reviewers performed data extraction from each included study, covering essential aspects such as: sample, patient demographics, type of surgery, prevalence/incidence, organs involved, and outcomes. Discrepancies in extraction were resolved by the reviewers after discussion.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFirstly, the analysis was done using Google sheet and X Miner extension for age distribution., and then age distribution was analyzed with a 95% confidence level. Next the results showed age distribution of multi organ failure syndrome, the number of multi organ failure syndrome per surgery and the differences in incidence and prevalence by type of surgery.\u003c/p\u003e"},{"header":"3.0 Results","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003eScreening and Study Selection:\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 1,332 records were obtained following initial search, of which 732 records were screened for inclusion following removal of duplicates. 22 records were further evaluated via a full-text screening, of which 14 were finally included for further qualitative synthesis [1-14]. A detailed PRISMA chart is provided in Figure 1.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eStudy characteristics:\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFourteen records with a total sample size of 8,267 patients were considered for qualitative analysis. These consisted of 11 cohort studies, 2 case-control studies, and one randomized controlled trial. These studies were published within the recent decade, ranging from 2016 to 2023. Records were mainly conducted in Europe and the USA, with few studies in China, Japan, and India.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eBaseline characteristics:\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study population comprised patients aged from 39 to 70 years old. Males formed a higher percentage of the population (n=4115, 49.78%). The type of surgery included pancreatectomy in 7 studies, cholecystectomy in 2 studies, and other procedures like esophagectomy.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eQuality assessment:\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eQuality assessment was performed using the NOS tool. Studies with a total score of 7 or more were considered to be \u0026ldquo;high\u0026rdquo; quality, while those below 7 were considered to be \u0026ldquo;poor\u0026rdquo; quality due to biases. Nine studies were deemed to be of high quality, while five studies were considered to be of poor quality, due to biasing in comparability between cohorts. Detailed quality assessment is provided in Table 1.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eOutcomes:\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe incidence of MFS among the patient population was 1,630 out of 8,267 patients (19.72%). The main organs involved include the liver, followed by the circulatory and coagulation system, and pulmonary complications. Sepsis and multi-organ dysfunction were reported in three studies. Of these patients, 57 (3.5%) died due to complications. A few reported complications include severe pancreatic necrosis, pancreatic fistula, chylothorax, and intra-abdominal infections.\u003c/p\u003e\n\u003cp\u003eA summary of the findings from the 14 included articles is provided by table 2,3,4 and 5 below.\u003c/p\u003e"},{"header":"4.0 Discussion","content":"\u003cp\u003e \u003cb\u003eAge\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThis study found that the mean age of patients affected by MODS after major abdominal surgery (MAS) was 57.6 (SE 2.7), which aligns with findings from other similar studies. For instance, a study examining the incidence of MODS following emergency non-cardiac admissions reported a mean age of 58.8 [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. Another study focusing on MODS after polytrauma found a mean age of 48, with an observed increase in age over the 10-year study period, attributed to the aging population in Australia [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. Notably, MODS patients were generally older than non-MODS patients admitted for polytrauma. However, a study analyzing risk factors for MODS caused by sepsis found no significant age difference between MODS and non-MODS groups [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOlder age has been associated with longer ICU stays and increased ventilator use, contributing to higher morbidity and greater resource utilization [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. Age, particularly over 50 years, is recognized as an independent risk factor for MODS across various scoring systems [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e] and is also a predictor of mortality [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. While the exact mechanisms remain unclear, potential factors include reduced physiologic reserve, the presence of comorbid conditions that impair the body\u0026rsquo;s response to injury, polypharmacy common in older adults, and other unidentified factors [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e \u003cb\u003eGender\u003c/b\u003e \u003c/p\u003e \u003cp\u003eAmong the 14 studies reviewed, 12 reported a higher prevalence of MODS in males, consistent with findings from other studies in different contexts. For example, Jansson et al. found that 62.5% of MODS patients were male [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e], while King et al reported that 81% of MODS patients following polytrauma were male, a proportion higher than that observed in non-MODS patients [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. Similarly, in post-sepsis MODS, males were found to have twice the likelihood of developing MODS compared to females. Males also tend to exhibit higher SOFA organ dysfunction scores, which may contribute to greater disease severity [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. This could be linked to higher levels of proinflammatory cytokines such as IL-6 in males, which may play a role in the pathophysiology of MODS [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Angele et al suggest that hormonal differences between genders may influence immune responses, with male hormones potentially exacerbating inflammation and female hormones offering protective effects, possibly explaining better outcomes in females [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. However, the relationship between gender and MODS incidence is complex.\u003c/p\u003e \u003cp\u003e \u003cb\u003eIncidence\u003c/b\u003e \u003c/p\u003e \u003cp\u003e The review found that the incidence of MODS among the studied patient population was 1,630 out of 8,267 patients, representing 19.72% of the sample. In a study examining MODS in trauma patients in Australia, the incidence was 2% of trauma patients, equivalent to 0.8 cases per 100,000 people. Among patients classified as at-risk for MODS, the incidence rose to 23% [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. Another study reported that 21% of post-injury patients at a trauma center developed MODS [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. A UK-based study found that the incidence of MODS in trauma patients within 24 hours was as high as 55%, translating to approximately 3,300 patients annually and 33,000 critical care bed days [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e \u003cb\u003eOrgan system involved\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe most commonly affected organ systems in this study were the liver, followed by the circulatory, coagulation, and pulmonary systems, consistent with findings in other studies of MODS. Another study reported that cardiac and respiratory failures were the most prevalent in post-injury patients, though these were associated with lower mortality compared to renal and hepatic failures (37%, 23%, 63%, and 50%, respectively) [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. Respiratory failure was linked to longer hospital stays, and it has been suggested that MODS progression often depends on respiratory failure as a catalyst. Renal and hepatic failures typically occur later in the disease course, which may explain their association with higher mortality [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. Cole et al similarly found that respiratory and cardiovascular dysfunctions were the primary contributors to MODS (97% and 91%, respectively), followed by central nervous system involvement [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. Recent studies have shown increased involvement of these systems compared to older studies, possibly due to the respiratory system\u0026rsquo;s susceptibility to inflammatory responses [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e]. The cardiovascular system plays a critical role in MODS progression, as derangements in cardiovascular parameters can lead to hypoxia and hypoperfusion, contributing to the failure of other organs [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e]. Patients with extreme organ dysfunction, particularly involving the renal and hepatic systems, often require more intensive ICU support [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e \u003cb\u003eMortality\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThis study reported a mortality rate of 3.5% among the selected patient population, which is lower than mortality rates associated with MODS due to other surgical-related causes. Ting found that mortality among MODS patients following trauma ranged between 6% and 17% across different trauma centers [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. Jansson et al. reported that mortality in MODS patients varied by care setting, with rates of 7.2% in the ICU overall and 12.4% in the hospital [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. However, the highest mortality rate (40.1%) was observed in patients admitted to the ICU from the emergency department, underscoring the importance of early recognition and management of organ failure [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. King et al. noted that polytrauma patients with MODS had higher mortality rates than their non-MODS counterparts, with mortality increasing with age [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. Mortality in MODS patients is influenced by multiple factors, including disease severity as measured by scoring systems such as APACHE II and SOFA, which are independent risk factors for death in patients with post-traumatic sepsis [\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e]. The number of organs involved is another critical determinant, with involvement of three or more organs associated with a mortality rate of 70%, highlighting the challenges in managing this condition [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e \u003cb\u003eImplications for clinical practice\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe study highlights several important aspects that have to be emphasized in the management of MODS post-abdominal surgery. First, monitoring and early detection of signs of decline in such high-risk patients is key due to the risk of exacerbation of comorbidities and progression of MODS. Clinical scoring systems such as SOFA and APACHE II should be integrated early into patient assessments to allow for clinicians to track progression of this condition. This in turn will enable early and targeted interventions for high-risk patients.\u003c/p\u003e \u003cp\u003ePatients in the emergency departments are at higher risk of mortality due to MODS especially due to failures in detection and early management. For this reason, a high index of suspicion should be maintained in patients presenting with signs of systemic inflammation and organ dysfunction. Diagnostic and therapeutic measures can then be implemented in a timely manner which will optimize outcomes.\u003c/p\u003e \u003cp\u003eThis study highlighted the vulnerability of the cardiovascular and respiratory systems early in the disease course of MODS as they are more likely to fail first. They thus require aggressive support through hemodynamic stabilization, adequate oxygenation, and ventilation to prevent further damage. In patients with prolonged stays in ICU, monitoring of their hepatic and renal systems gets more priority as they are vulnerable to secondary injuries later in the disease course and can influence clinical outcomes.\u003c/p\u003e \u003cp\u003eIntegration of risk stratification scores such as SOFA and APACHE II into clinical workflows has also been emphasized. These scores give an objective method for assessing disease severity and influencing aspects of therapy. They can also give an aid to communicating prognosis to patients and their families. The standardized nature of the scores allows comparisons between different clinical settings. On this note, there is a need for integration of these scores internationally to further streamline comparisons in different contexts.\u003c/p\u003e \u003cp\u003eIn summary, the findings of this study call for a proactive, systematic approach to the management of MODS, with an emphasis on early detection, aggressive organ support, and the integration of validated scoring systems into routine clinical practice. By adopting these strategies, healthcare providers can improve patient outcomes, reduce mortality, and enhance the overall quality of care for individuals at risk of MODS.\u003c/p\u003e"},{"header":"5.0 Limitations","content":"\u003cp\u003eThis systematic review, despite providing valuable insights into MODS, has several limitations. The quality of findings of this paper depends on the rigor of the included articles. In addition, the articles have used different definitions of MODS which introduces bias into the findings. Heterogeneity of the patient populations and surgical procedures included for analysis limits generalizability of these results. In addition, there is a possibility of publication bias as inconclusive studies may have been excluded for analysis. Studies not published in English were excluded, and a search of gray literature was not done, further limiting the scope of the review. A few of the studies were conducted many years ago and the standard of practice then may not be reflective of what is done now. Since the review synthesizes observational data, causative relationships between MODS and abdominal surgery cannot be derived. Finally, the included studies were done in diverse health systems with different practices and resources which limits generalizability of these results.\u003c/p\u003e"},{"header":"6.0 Conclusion","content":"\u003cp\u003eIn critically sick patients, especially those after major abdominal surgery, Multiple Organ Dysfunction Syndrome (MODS) continues to be a significant concern. Organ cross-talk, systemic inflammatory responses, and other perioperative problems interact intricately to create this complicated disease. The exact pathophysiology of MODS is still unclear after decades of research, hence further study into its causes is required.\u003c/p\u003e \u003cp\u003eEven though they make up a smaller portion of all surgeries, high-risk surgical procedures have a major impact on the morbidity and mortality associated with surgery. To reduce the incidence of MODS, this emphasizes the significance of early detection, efficient perioperative care, and focused therapies. Results have been somewhat enhanced by developments in organ support systems, hemodynamic monitoring, and surgical methods. Innovative therapy strategies, such as fecal microbiota transplantation, gut microbiota targeting, and molecular mediators implicated in MODS development, are desperately needed.\u003c/p\u003e \u003cp\u003eThe frequency, risk factors, and treatment approaches for MODS after major abdominal surgery are highlighted in this study. In order to enhance patient outcomes, it highlights the significance of preventative efforts and the necessity of interdisciplinary teamwork. In order to lessen the burden of MODS in surgical and trauma patients, it also promotes investigating new treatments and improving long-term care strategies. To further address the problems of this life-threatening illness, future research should concentrate on discovering biomarkers for early identification, enhancing perioperative treatment, and figuring out the molecular processes behind organ malfunction.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eConflict of interest:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Authors declare no conflicts of interest\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo funding was available for this study\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInitial Idea:\u0026nbsp;\u003c/strong\u003eM.A.Y and F.H\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLiterature search:\u0026nbsp;\u003c/strong\u003eA.M.K, V.I, M.G\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eWriting article:\u0026nbsp;\u003c/strong\u003eM.A.Y, A.M.K, N.P.E, V.I, S.T.B.S.S, M.I, N.G.O.A, S.R, J.G.T\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFinal Approval:\u0026nbsp;\u003c/strong\u003eF.H, M.A.Y, A.M.K\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCopyright and Publishing Agreement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBy submitting this manuscript to\u0026nbsp;\u003cem\u003eDigestive Diseases and Sciences\u0026nbsp;\u003c/em\u003eJournal, all authors agree to transfer copyright of the published work to the journal. 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The multiple organ dysfunction syndrome. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.ncbi.nlm.nih.gov/books/NBK6868/\u003c/span\u003e\u003cspan address=\"https://www.ncbi.nlm.nih.gov/books/NBK6868/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEriksson J, Nelson D, Holst A, Hellgren E, Friman O, Oldner A. Temporal patterns of organ dysfunction after severe trauma. Crit Care. 2021;5;25(1):165.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTong Y, Zhang J, Fu Y, He X, Feng Q. Risk factors and outcome of sepsis in traumatic patients and pathogen detection using metagenomic next-generation sequencing. Can J Infect Microbiol M\u0026eacute;dicale. Published online 2022.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTables 1 to 8 are available in the Supplementary Files section\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Multiple Organ Dysfunction Syndrome (MODS), Major Abdominal Surgery, Perioperative Complications, Systemic Inflammatory Response","lastPublishedDoi":"10.21203/rs.3.rs-6187343/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6187343/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eIntroduction:\u003c/h2\u003e \u003cp\u003eMultiple Organ Dysfunction Syndrome (MODS) is a life-threatening condition, characterized by the failure of two or more organ systems. It often follows a Major Abdominal Surgery (MAS). Even with improved surgical care, it remains a leading cause of ICU related deaths. Its pathophysiology is still not clearly understood and data on management is limited.\u003c/p\u003e\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eThis systematic review aims to analyze trends and clinical outcomes of multiple organ failure following a major abdominal surgery.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA comprehensive literature search was conducted using SCOPUS, Web of Science and MEDLINE (via PubMed) to identify studies on multiple organ failure following a major abdominal surgery.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe study reviewed 14 articles involving 8,267 patients and found a 19.27% incidence of MODS. The systems mainly affected were the liver, circulatory, coagulation and pulmonary systems. Mortality was 3.5%, influenced by disease severity and organ involvement.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eMultiple Organ Dysfunction Syndrome (MODS) remains an important concern following major abdominal surgery. This review shows age, gender, and organ involvement as key factors in its development. Early detection using scoring systems have been found to be crucial for management. However, variability in studies limits generalizability, requiring further research.\u003c/p\u003e","manuscriptTitle":"Multiorgan Failure Post-Abdominal Surgery: A Systematic Review of Trends and Clinical Outcomes","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-03-18 07:34:41","doi":"10.21203/rs.3.rs-6187343/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"af6d2026-5caf-4908-986c-95d4470703ba","owner":[],"postedDate":"March 18th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-03-18T07:34:41+00:00","versionOfRecord":[],"versionCreatedAt":"2025-03-18 07:34:41","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6187343","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6187343","identity":"rs-6187343","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}