Planned Relaparotomy vs Relaparotomy on Demand in the Treatment of Intra-abdominal Infections
Toni Hau, MD, PhD;
Christian Ohmann, PhD;
Achim Wolmershäuser, MD;
Hannes Wacha, MD, PhD;
Qin Yang, PhD
Arch Surg. 1995;130(11):1193-1197.
Abstract
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Objective
To define the role of planned relaparotomy (PR) in the treatment of intraperitoneal infection, compared with that of relaparotomy on demand (RD).
Design
Case-control study on the basis of a prospective multicenter cohort analytic study. Statistical evaluation was done by the McNemar test for qualitative data and the Wilcoxon matched-pairs signed rank test for qualitative data.
Setting
Eighteen hospitals of different care levels in Austria, Germany, and Switzerland.
Patients
Thirty-eight of 42 patients with intraabdominal infections who underwent PR were matched for APACHE II (Acute Physiology and Chronic Health Evaluation II) score, age, cause of infection, site of origin of peritonitis, and the ability of the surgeon to securely eliminate the source of infection with 38 patients taken from a cohort of 278 undergoing RD.
Interventions
Planned relaparotomy was defined as at least one relaparotomy decided on at the time of the first surgical intervention; RD, relaparotomy indicated by clinical findings.
Main Outcome Measures
Mortality and incidence of postoperative multiple organ failure and infectious complications.
Results
There was no significant difference in mortality between patients treated with PR (21%) or RD (13%). Postoperative multiple organ failure as defined by a Goris score of more than 5 was more frequent in the group of patients undergoing PR (50%), compared with the group undergoing RD (24%) (P=.01), as were infectious complications (68% vs 39% [P=.01]). Infectious complications were due to more frequent suture leaks (16% vs 0% [P=.05]), recurrent intra-abdominal sepsis (16% vs 0% [P=.05]), and septecemia (45% vs 18% [P=.05]) in the PR vs the RD groups. The incidence of other complications was not different in the two groups.
Conclusions
Until larger prospective studies are available, the indication for PR should be evaluated with caution.
(Arch Surg. 1995;130:1193-1197)
Author Affiliations
for the Peritonitis Study Group of the Surgical Infection Society–Europe
From the Department of General, Thoracic, and Vascular Surgery, Nordwest-Krankenhaus Sanderbusch, Sande, Germany (Dr Hau); the Theoretical Surgical Division, Department of General and Trauma Surgery, Heinrich Heine University, Düsseldorf, Germany (Drs Ohmann, Wolmershäuser, and Yang); and the Department of Surgery, Hospital zum Heiligen Geist, Frankfurt, Germany (Dr Wacha). Members of the Peritonitis Study Group of the Surgical Infection Society–Europe who contributed patients to this study are listed on page 1196.
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