Decision making for relaparotomy in secondary peritonitis

Area of Science:

• Surgical decision-making
• Clinical variable analysis
• Relaparotomy outcomes

Background:

• Surgeons' qualitative ranking of clinical variables influencing reoperation decisions is crucial.
• Understanding these variables' relationship to positive findings at relaparotomy is key.

Purpose of the Study:

• To qualitatively rank clinical variables influencing surgeons' reoperation decisions.
• To evaluate if these variables predict positive findings during relaparotomy.

Main Methods:

• 21 factors assessed using a 10-point visual analogue scale (VAS).
• Variables with median VAS scores >5.0 deemed 'important'.
• Multivariate analysis used to evaluate predictive value for positive findings.

Main Results:

• 64% response rate; wide VAS score variation observed.
• Diffuse abdominal contamination, infectious focus localization, and leukocyte counts predicted positive relaparotomy.
• These variables showed only moderate predictive accuracy (c-statistic 0.69).

Conclusions:

• No consensus among surgeons regarding important reoperation decision variables.
• Only three of ten 'important' variables independently predicted positive relaparotomy.
• The set of predictive variables had moderate accuracy for positive relaparotomy findings.