Quality of life after severe bacterial peritonitis and infected necrotizing pancreatitis treated with open management of the abdomen and planned re-operations.
OBJECTIVE
To determine quality of life after severe bacterial peritonitis and infected necrotizing pancreatitis treated with open management of the abdomen and planned re-operations.


METHODS
Retrospective chart review.


METHODS
University hospital intensive care unit, general wards, and outpatient department.


METHODS
Forty-one patients who survived severe bacterial peritonitis and infected necrotizing pancreatitis treated with open management of the abdomen and planned re-operations.


METHODS
None.


RESULTS
Over a period of 7 yrs, 95 patients underwent open management of the abdomen and planned re-operations for severe bacterial peritonitis and infected necrotizing pancreatitis. Thirty-nine patients died during the initial intensive care unit stay and 12 as a result of nonperitonitis-related systemic diseases after discharge. Four patients were lost or excluded from final analysis. Long-term morbidity and quality of life using Karnofsky and Rankin scores at discharge and at follow-up at least 1 yr after discharge (mean: 4 yrs) and the Sickness Impact Profile (SIP) were determined. The remaining 41 patients reviewed showed significant long-term morbidity, including dysfunction of the abdominal wall resulting from herniation, persistent polyneuropathy, and mental disorders needing psychiatric support. Patients having persistent polyneuropathy and, to a lesser extent, mental disorders, showed significantly lower Karnofsky, higher Rankin, and higher SIP scores. After discharge, performance status of patients improved significantly, as shown by higher Karnofsky and lower Rankin scores, and, because Karnofsky and Rankin scores are closely related to SIP scores, higher SIP scores. Especially in measuring quality of life in terms of social and role management, assessment of the SIP proved to have additional value.


CONCLUSIONS
About three-quarters of patients who survive open management of the abdomen and planned re-operations for severe bacterial peritonitis and infected necrotizing pancreatitis regain a good quality of life. Some patients, especially those who suffer from persistent polyneuropathy and mental disorders, show restrictions in daily life.
Bosscha
K
K
Department of Surgery, University Hospital Utrecht, Heidelberglaan 100, 3585 CX Utrecht, The Netherlands.
Reijnders
K
K
Jacobs
M H
MH
Post
M W
MW
Algra
A
A
van der Werken
C
C
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003422:Critical Care; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D017567:Karnofsky Performance Status; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000401:mortality; D019283:Pancreatitis, Acute Necrotizing / Q000150:complications / Q000601:surgery*; D010538:Peritonitis / Q000150:complications / Q000601:surgery*; D011115:Polyneuropathies; D011788:Quality of Life; D012189:Retrospective Studies; D018434:Sickness Impact Profile