title: Relaparotomy for suspected intraperitoneal sepsis after abdominal surgery.
abstract: Relaparotomy may be beneficial in patients developing intraperitoneal sepsis after abdominal procedures. We determined whether joint clinical assessment by intensivist and surgeon (clinician assessment) identified patients with surgically correctable intraperitoneal sepsis. We also assessed the effect of patient age and sex, disease presentation and severity, interval to relaparotomy, and the number of relaparotomies on survival after relaparotomy. Data on clinical, laboratory, and radiologic abnormalities prior to relaparotomy, relaparotomy findings, and in-hospital survival were prospectively collected on a general hospital intensive care unit (ICU) database between January 1997 and January 2002. Altogether, 65 of 1482 (4.4%) patients admitted to the ICU after abdominal surgery underwent relaparotomy at a median of 5 days after the initial procedure. There was an 83% probability of identifying surgically treatable sepsis and 43% in-hospital mortality. Abdominal imaging contributed accurate information in 50% of cases where clinician assessment was uncertain. Patient age and multiorgan failure prior to relaparotomy-but not urgency of initial laparotomy or the acute physiology and chronic health evaluation (APACHE II) score prior to relaparotomy, interval to relaparotomy, or number of relaparotomies-affected the outcome. Clinician assessment after abdominal surgery had a high probability of predicting intraperitoneal sepsis at relaparotomy. The 43% mortality after relaparotomy was unlikely to be greater than with nonoperative treatment of intraabdominal sepsis, but the 78% mortality after relaparotomy in patients older than 75 years of age raised doubts about this approach in the elderly. The identification of intraperitoneal sepsis and performance of relaparotomy earlier after the initial abdominal surgery might reduce the high rate (60%) of multiorgan failure prior to relaparotomy and improve survival after it.
authors.affiliation: Department of Surgery, Faculty of Medicine, Imperial College of Science, Technology and Medicine, London, UK.
authors.forename: Robert R
authors.initials: RR
authors.lastname: Hutchins
authors.forename: M Paul
authors.initials: MP
authors.lastname: Gunning
authors.forename: D Nuala
authors.initials: DN
authors.lastname: Lucas
authors.forename: Timothy G
authors.initials: TG
authors.lastname: Allen-Mersh
authors.forename: Neil C
authors.initials: NC
authors.lastname: Soni
mesh_terms: D018806:APACHE; D000328:Adult; D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D003937:Diagnosis, Differential; D004066:Digestive System Diseases / Q000601:surgery*; D005260:Female; D005831:Genital Diseases, Female / Q000601:surgery*; D006555:Hernia, Ventral / Q000601:surgery*; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D010348:Patient Care Team; D010538:Peritonitis / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D011379:Prognosis; D012086:Reoperation / Q000401:mortality; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D015996:Survival Rate