Repeated laparotomy for postoperative intra-abdominal sepsis. An analysis of outcome predictors
J. A. Butler, J. Huang and S. E. Wilson
To identify factors modifying the outcome of reoperation for
intra-abdominal infection, we analyzed the management of 47 patients who
underwent repeated laparotomy from July 1980 through July 1985. Overall
mortality was 30% (14/47). Factors predictive of death were as follows: age
greater than 60 years (86% mortality vs 21% mortality), preoperative vs no
organ failure (57% vs 6%), multiple vs single abscess (53% vs 16%), and
exploratory vs directed operative approach (39% vs 17%). Although the
interval between the primary surgery and reoperation was similar between
survivors (13 days) and nonsurvivors (14 days), five (36%) of 14
nonsurvivors were in septic shock and eight (57%) of 15 survivors showed
evidence of organ failure prior to reoperation. The median survival period
following reoperation in this group was only four days. Computed tomography
(CT) and/or ultrasonography were performed to localize a source of
infection in 24 patients. In nine (82%) of 11 patients, CT identified the
abscess, while ultrasonography was positive in 15 (72%) of 21 patients.
Neither the interval to operation nor the mortality was significantly
different in patients diagnosed with CT and ultrasonography when compared
with those who underwent exploration on the basis of clinical findings. To
lower the mortality and to shorten the interval to reoperation in these
high-risk patients, noninvasive diagnostic testing and confirmation by
percutaneous sampling must be sought before the onset of clinical sepsis
and organ failure.
