title: The Acute Physiology and Chronic Health Evaluation II score is helpful in predicting the need of relaparotomies in patients with secondary peritonitis of colorectal origin.
abstract: BACKGROUND
  Secondary peritonitis of colorectal origin has considerable morbidity and mortality. Relaparotomies are frequently necessary in the course of the disease. The objective of this study was to evaluate several scores in terms of their predictive value, i.e. whether Mannheim Peritonitis Index (MPI), Acute Physiology And Chronic Health Evaluation (APACHE) II, or Colorectal Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity (CR-POSSUM) scores can predict relaparotomies.
  
  
  METHODS
  Charts of 147 patients treated for secondary peritonitis of colorectal origin were retrospectively reviewed, MPI, APACHE II, and CR-POSSUM scores were calculated, and groups of patients with or without relaparotomies were compared.
  
  
  RESULTS
  Thirty-four percent of patients underwent one or more relaparotomies. Patients with relaparotomies showed a significantly higher APACHE II score than patients without relaparotomies (p = 0.004). MPI (p = 0.072) and CR-POSSUM score (p = 0.319) did not differ between the two groups. A high APACHE II score was also significantly associated with the need for a relaparotomy on demand (p <0.001), and for the combined outcome parameter relaparotomy and/or an interventional drainage (p = 0.046). Both other scores were not predictive for these outcomes. Overall in-hospital mortality was 21.8%. All three scores investigated were predictive for mortality. Sensitivity was 62.5%, 78.1%, and 75.0% for MPI, APACHE II score, and CR-POSSUM score, respectively.
  
  
  CONCLUSIONS
  The Acute Physiology And Chronic Health Evaluation II score might be helpful in predicting the need for relaparotomies in patients with secondary peritonitis of colorectal origin.
authors: Department of Surgery, University Hospital Basel, Switzerland. cviehl@uhbs.ch
authors: Carsten T
authors: CT
authors: Viehl
authors: Rebecca
authors: R
authors: Kraus
authors: Manuel
authors: M
authors: Zürcher
authors: Thomas
authors: T
authors: Ernst
authors: Daniel
authors: D
authors: Oertli
authors: Christoph
authors: C
authors: Kettelhack
mesh_terms: D018806:APACHE; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003108:Colonic Diseases / Q000150:complications; D004322:Drainage; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D010538:Peritonitis / Q000209:etiology* / Q000601:surgery*; D011237:Predictive Value of Tests; D012372:ROC Curve; D012002:Rectal Diseases / Q000150:complications; D012086:Reoperation; D012189:Retrospective Studies; D012720:Severity of Illness Index; D055815:Young Adult