Preoperative risk factors for mortality after relaparotomy: analysis of 254 patients.
BACKGROUND
The aim of this work was to analyze preoperative mortality risk factors after relaparotomy for abdominal surgery in a unit of General Surgery at a University Hospital.


METHODS
A total of 314 relaparotomies in 254 patients were performed between February 2004 and February 2008. We analyzed data about past medical history, first operation, as well as clinical and biochemical parameters previous to reoperation.


RESULTS
Indications for relaparotomy were peritonitis, bleeding, abscess, exploratory laparotomy, and evisceration. Overall mortality was 22%. Mortality of the patients with a single relaparotomy was 20% vs. 44% if they were reoperated upon twice. Mortality was associated with age, past history of cardiovascular disease, active neoplasm, previous treatment with platelet anti-aggregant drugs, first surgery American Society of Anesthesia score, and the presence of an anastomosis. Preoperative data associated with mortality were the number of systemic inflammatory response syndrome criteria, suture dehiscense, ileus, positive blood cultures, mechanical ventilation, artificial nutrition, antibiotics or vasoactive drugs, tachycardia, and abnormal body temperature. High white blood cell count or bilirrubin levels and low albumin or prothrombin time were also associated with mortality. Multivariate logistic regression analysis isolated age (P = 0.02), abnormal body temperature (P = 0.02), and the need of mechanical ventilation (P = 0.004) as independent preoperative variables predictive for mortality after relaparotomy.


CONCLUSIONS
Advanced age, the presence of either fever or hypothermia, and the need of mechanical ventilation are preoperative risk factors associated with mortality after relaparotomy and should be considered when planning reintervention.
Martínez-Casas
Isidro
I
Secció de Cirurgia d'Urgències, Servei de Cirurgia General i Digestiva, Hospital Universitari del Mar. IMAS, Passeig Marítim 25-29, 08003, Barcelona, Spain. 93929@imas.imim.es
Sancho
Juan J
JJ
Nve
Esther
E
Pons
Maria-José
MJ
Membrilla
Estela
E
Grande
Luis
L
D016009:Chi-Square Distribution; D013505:Digestive System Surgical Procedures / Q000401:mortality*; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000401:mortality*; D006801:Humans; D007813:Laparotomy / Q000401:mortality*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality*; D012086:Reoperation; D012307:Risk Factors; D013520:Urologic Surgical Procedures / Q000401:mortality*