title: Preoperative prognostic factors for severe diffuse secondary peritonitis: a retrospective study.
abstract: OBJECTIVE
  The aim of this study was to analyse preoperative risk factors for mortality or intensive care unit admission to describe severe peritonitis.
  
  
  METHODS
  This was a single academic centre retrospective study of consecutive adult patients operated for diffuse secondary peritonitis between 2012 and 2013. Patients with appendicitis or cholecystitis were excluded. Independent risk factors were identified using binary and ordinal logistic regression.
  
  
  RESULTS
  A total of 223 patients were analysed. Overall 30-day mortality was 14.5 %. Postoperatively, 32.3 % of patients were admitted into the intensive care unit (ICU). Independent risk factors for severe peritonitis were septic shock (odds ratio (OR) 37.94, 95 % confidence interval (CI) 14.52-99.13), chronic kidney insufficiency (OR 5.98 (95 % CI 1.56-22.86), severe sepsis (OR 4.80, 95 % CI 2.10-10.65) and cardiovascular disease (OR 2.58, 95 % CI 1.22-5.47). Patients lacking these factors had no mortality. ICU admission was refused in 24 (10.8 %) patients with 70.8 % mortality. In a subgroup of patients without treatment limitations (n = 190), independent risk factors for weighted outcome of ICU admission or mortality were septic shock (OR 11.89, 95 % CI 4.98-28.40), severe sepsis (OR 5.56, 95 % CI 2.39-12.89), metastatic malignant disease or lymphoma (OR 3.11, 95 % CI 1.34-7.20) and corticosteroid use (OR 2.98, 95 % CI 1.18-7.51). When receiving full level of care, patients with preoperative organ dysfunctions in this subgroup had 8.2 % 30-day mortality.
  
  
  CONCLUSIONS
  Preoperative organ dysfunctions, chronic kidney insufficiency and cardiovascular disease are the most important risk factors for severe peritonitis. Without these risk factors, patients had no mortality.
authors.affiliation: Department of Abdominal Surgery, University of Helsinki and Helsinki University Hospital Meilahti, Haartmaninkatu 4, 00290, Helsinki, Finland. matti.tolonen@hus.fi.
authors.forename: Matti
authors.initials: M
authors.lastname: Tolonen
authors.affiliation: Department of Abdominal Surgery, University of Helsinki and Helsinki University Hospital Meilahti, Haartmaninkatu 4, 00290, Helsinki, Finland.|Department of Transplantation and Liver Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
authors.forename: Ville
authors.initials: V
authors.lastname: Sallinen
authors.affiliation: Department of Abdominal Surgery, University of Helsinki and Helsinki University Hospital Meilahti, Haartmaninkatu 4, 00290, Helsinki, Finland.
authors.forename: Panu
authors.initials: P
authors.lastname: Mentula
authors.affiliation: Department of Abdominal Surgery, University of Helsinki and Helsinki University Hospital Meilahti, Haartmaninkatu 4, 00290, Helsinki, Finland.
authors.forename: Ari
authors.initials: A
authors.lastname: Leppäniemi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000150:complications; D003422:Critical Care; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000150:complications; D010538:Peritonitis / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery; D011379:Prognosis; D051436:Renal Insufficiency, Chronic / Q000150:complications; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult
keywords: Critical care; Intraabdominal infections; Laparotomy; Multiple organ failure; Sepsis