Decision making for relaparotomy in secondary peritonitis.
OBJECTIVE
To provide a qualitative ranking of clinical variables by surgeons that influence their decision for reoperation and to evaluate whether these variables are related to positive findings at relaparotomy.


METHODS
Importance in decision making for relaparotomy was evaluated for 21 factors using a 10-point visual analogue scale (VAS). Variables with median VAS scores >5.0 were labeled 'important'. Predictive value for positive findings was evaluated by multivariate analysis.


RESULTS
The response rate was 64%. For each variable, a wide range of VAS scores was given. Of variables labeled 'important', a diffuse extent of abdominal contamination (odds ratio, OR 1.9; 95% CI 0.99-3.8; p = 0.052), localization of the infectious focus (upper gastrointestinal tract including small bowel: OR 2.6, 95% CI 0.98-7.0, p = 0.055; colon: OR 2.4, 95% CI 0.93-6.0, p = 0.071), and both low (<3 x 10(9)/l: OR 4.6, 95% CI 1.3-17, p = 0.021) and high (>20 x 10(9)/l: OR 2.2, 95% CI 1.0-4.9, p = 0.042) leukocyte counts independently predicted positive relaparotomy. As a set, these variables had only moderate predictive accuracy (c-statistic 0.69).


CONCLUSIONS
There was no consensus among surgeons which variables were important in decision making for relaparotomy. Only three out of ten variables labeled as 'important' were indeed independently predictive, but even as a set had only moderate predictive accuracy.
van Ruler
O
O
Department of Surgery, Biostatistics and Bioinformatics, Academic Medical Center, Amsterdam, The Netherlands.
Lamme
B
B
de Vos
R
R
Obertop
H
H
Reitsma
J B
JB
Boermeester
M A
MA
D000328:Adult; D000368:Aged; D003657:Decision Making; D005260:Female; D006306:Health Surveys; D006801:Humans; D007813:Laparotomy; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010538:Peritonitis / Q000175:diagnosis* / Q000601:surgery*; D011237:Predictive Value of Tests; D012086:Reoperation; D018570:Risk Assessment; D012307:Risk Factors