Relaparotomy for suspected intraperitoneal sepsis after abdominal surgery

Area of Science:

• Surgical critical care
• Intensive care medicine

Background:

• Relaparotomy is considered for post-abdominal surgery intraperitoneal sepsis.
• Accurate identification of surgically correctable sepsis is crucial for patient outcomes.

Purpose of the Study:

• To evaluate the efficacy of joint clinical assessment by intensivist and surgeon in identifying surgically correctable intraperitoneal sepsis.
• To determine factors influencing survival after relaparotomy, including patient demographics, disease severity, and timing of intervention.

Main Methods:

• Prospective data collection from an intensive care unit (ICU) database (1997-2002).
• Analysis included clinical, laboratory, and radiologic findings prior to relaparotomy, operative findings, and in-hospital survival.
• Assessment of patient age, sex, disease presentation, severity, interval to relaparotomy, and number of relaparotomies.

Main Results:

• Of 1482 patients, 65 (4.4%) underwent relaparotomy. Clinician assessment predicted surgically treatable sepsis with 83% probability.
• In-hospital mortality after relaparotomy was 43%.
• Patient age and pre-relaparotomy multiorgan failure significantly impacted survival; APACHE II score, interval, and number of relaparotomies did not.

Conclusions:

• Joint clinician assessment effectively identifies patients requiring relaparotomy for intraperitoneal sepsis.
• Relaparotomy mortality (43%) may be comparable to nonoperative management, but survival is poor in elderly patients (>75 years).
• Earlier identification and intervention for intraperitoneal sepsis may reduce multiorgan failure and improve survival post-relaparotomy.