Mortality and morbidity of planned relaparotomy versus relaparotomy on demand for secondary peritonitis.
BACKGROUND
Planned relaparotomy (PR) and relaparotomy on demand (ROD) are both frequently used in the treatment of secondary peritonitis. The aim of this study was to evaluate the mortality, morbidity and long-term outcome associated with PR compared with ROD in patients with secondary peritonitis admitted to a university hospital.


METHODS
This retrospective study included 278 consecutive patients who underwent emergency laparotomy for secondary peritonitis between January 1994 and January 2000. Outcome was analysed based on the decision made by the surgeon during the first operation to perform either ROD (197 patients) or PR (81).


RESULTS
The Acute Physiology And Chronic Health Evaluation II score was comparable in ROD and PR groups (10.8 versus 11.7; P = 0.222). The in-hospital mortality rate was significantly lower with ROD than PR (21.8 versus 36 per cent; P = 0.016). Two-year survival(s.e.) was 65.8(3.4) per cent in the ROD group and 55.5(5.5) per cent in the PR group (P = 0.031).


CONCLUSIONS
The in-hospital and long-term survival rates were higher in patients with secondary peritonitis treated by ROD than in those with disease of comparable severity treated by PR. Choice of treatment strategy was an independent predictor of survival.
Lamme
B
B
Department of Surgery (G4-134), Academic Medical Centre, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
Boermeester
M A
MA
Belt
E J T
EJ
van Till
J W O
JW
Gouma
D J
DJ
Obertop
H
H
D000368:Aged; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007813:Laparotomy / Q000009:adverse effects / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D010538:Peritonitis / Q000209:etiology / Q000401:mortality* / Q000601:surgery; D011379:Prognosis; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate