title: Comparison of on-demand vs planned relaparotomy for treatment of severe intra-abdominal infections.
abstract: OBJECTIVE
  To compare morbidity and mortality of patients with severe intra-abdominal infections after two types of surgical treatment, on-demand ("wait and see") relaparotomy and modified planned relaparotomy.
  
  
  METHODS
  We prospectively analyzed the outcomes of 65 patients with severe peritonitis surgically treated in two Croatian hospitals. In one hospital, 34 patients were treated on-demand, and in another hospital 31 patients were treated by planned relaparotomy. We compared severe postoperative complications, mortality, and length of hospital stay in the two groups of patients.
  
  
  RESULTS
  Severity of patient's disease, as measured from preoperative group-average Acute Physiology and Chronic Health Evaluation (APACHE) II scores, was comparable in both on-demand and planned relaparotomy groups. The mortality rate was higher in patients operated on-demand (59% vs 29%, P=0.024). In nonadjusted model, the relative risk of dying was 2.5-fold higher for patients treated by on-demand operation in comparison with planned relaparatomy (P=0.030). However, after the adjustment of the survival data for individual patient's sex and APACHE II scores, the difference in the relative risk became non-significant (P=0.178). The patients who died had higher APACHE II scores (26.1+/-8.9 vs 19.7+/-5.9, P=0.009). Relative risk of dying per 5-point increase in APACHE II score was 1.24 (95% confidence interval, 1.01-1.51; P=0.039), irrespective of the surgical technique.
  
  
  CONCLUSIONS
  Patients with severe peritonitis treated with planned relaparotomy seemed to have lower mortality. However, the relative risk of dying was not statistically different between the on-demand and planned relaparotomy groups after adjustment for preoperative APACHE II scores. The severity of disease rather than surgical approach plays more important role in survival of these patients.
authors.affiliation: Department of Anesthesiology, MB 2-752, Mayo Clinic College of Medicine, 200 First Street, SW, Rochester, MN 55905, USA.
authors.forename: Mladen
authors.initials: M
authors.lastname: Rakić
authors.forename: Drago
authors.initials: D
authors.lastname: Popović
authors.forename: Mislav
authors.initials: M
authors.lastname: Rakić
authors.forename: Nikica
authors.initials: N
authors.lastname: Druzijanić
authors.forename: Mihajlo
authors.initials: M
authors.lastname: Lojpur
authors.forename: Brian A
authors.initials: BA
authors.lastname: Hall
authors.forename: Brent A
authors.initials: BA
authors.lastname: Williams
authors.forename: Juraj
authors.initials: J
authors.lastname: Sprung
mesh_terms: D034841:Abdominal Cavity / Q000382:microbiology* / Q000473:pathology / Q000601:surgery; D000368:Aged; D005260:Female; D006801:Humans; D007813:Laparotomy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010347:Patient Care Planning; D010538:Peritonitis / Q000382:microbiology / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications / Q000401:mortality*; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012086:Reoperation; D012306:Risk; D012720:Severity of Illness Index; D016019:Survival Analysis; D017211:Treatment Failure; D016896:Treatment Outcome