Acute prognosis of critically ill patients with secondary peritonitis: the impact of the number of surgical revisions, and of the duration of surgical therapy.
BACKGROUND
Duration of surgical therapy and the number of surgical revisions performed to control the focus may be important prognostic variables. Association of such time-dependent therapies with survival, however, has not yet been studied.


METHODS
We analyzed survival times of adult patients (n = 283) who were suffering from secondary peritonitis and associated organ failure. Cox-type additive hazard regression models were used to analyze associations of surgical variables with survival time.


RESULTS
Seventy-two patients (25.4%) survived the period of excess mortality after intensive care unit admission. A total of 79.5% of the 283 patients required one or more surgical revisions. Besides the underlying disease and disease severity at intensive care unit admission, there was a nonlinear smoothed association between a poorer outcome and the duration of surgical therapy, and the number of surgical revisions. For the latter, hazard ratios increased sharply between 1 and 5 revisions, and remained largely constant later on.


CONCLUSIONS
In critically ill patients with peritonitis, a long therapy and the necessity for a high number of reoperations is related inversely to acute survival.
Department of Surgery, Campus Grosshadern, Ludwig-Maximilians-University Munich, Marchioninistrasse 15, Munich, Germany.
Dominik
D
Rüttinger
David
D
Kuppinger
Manuela
M
Hölzwimmer
Sabrina
S
Zander
Markus
M
Vilsmaier
Helmut
H
Küchenhoff
Karl-Walter
KW
Jauch
Wolfgang H
WH
Hartl
D018806:APACHE; D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017714:Community-Acquired Infections / Q000401:mortality / Q000601:surgery; D015986:Confounding Factors, Epidemiologic; D003422:Critical Care; D016638:Critical Illness / Q000401:mortality*; D005260:Female; D005858:Germany / Q000453:epidemiology; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010538:Peritonitis / Q000209:etiology / Q000401:mortality* / Q000601:surgery*; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D012086:Reoperation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome