title: Meta-analysis of relaparotomy for secondary peritonitis.
abstract: BACKGROUND
  Planned relaparotomy and relaparotomy on demand are two frequently employed surgical treatment strategies for patients with abdominal sepsis.
  
  
  METHODS
  The available literature was evaluated to compare the efficacy of both surgical treatment strategies. A systematic search for studies comparing planned and on-demand relaparotomy strategies in adult patients with secondary peritonitis was employed. Studies were reviewed independently for design features, inclusion and exclusion criteria, and outcomes. The primary outcome measure was in-hospital mortality.
  
  
  RESULTS
  No randomized studies were found; eight observational studies with a total of 1266 patients (planned relaparotomy, 286; relaparotomy on demand, 980) met the inclusion criteria and were included in the meta-analysis. These eight studies were heterogeneous on clinical and statistical grounds (chi2= 40.7, d.f. = 7, P < 0.001). Using a random-effects approach, the combined odds ratio for in-hospital mortality was 0.70 (95 per cent confidence interval 0.27 to 1.80) in favour of the on-demand strategy.
  
  
  CONCLUSIONS
  The combined results of observational studies show a statistically non-significant reduction in mortality for the on-demand relaparotomy strategy compared with the planned relaparotomy strategy when corrected for heterogeneity in a random-effects model. Owing to the non-randomized nature of the studies, the limited number of patients per study, and the heterogeneity between studies, the overall evidence generated by the eight studies was inconclusive.
authors.affiliation: Departments of Surgery and Clinical Epidemiology and Biostatistics, Academic Medical Centre, University of Amsterdam, The Netherlands. B.Lamme@amc.uva.nl
authors.forename: B
authors.initials: B
authors.lastname: Lamme
authors.forename: M A
authors.initials: MA
authors.lastname: Boermeester
authors.forename: J B
authors.initials: JB
authors.lastname: Reitsma
authors.forename: C W
authors.initials: CW
authors.lastname: Mahler
authors.forename: H
authors.initials: H
authors.lastname: Obertop
authors.forename: D J
authors.initials: DJ
authors.lastname: Gouma
mesh_terms: D018806:APACHE; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007813:Laparotomy / Q000379:methods* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D010538:Peritonitis / Q000209:etiology / Q000601:surgery*; D012008:Recurrence; D012086:Reoperation; D016896:Treatment Outcome