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Postoperative Peritonitis After Digestive Tract Surgery: Surgical Management and Risk Factors for Morbidity and
Thierry Bensignor1, Jérémie H Lefevre2, Ben Creavin3
1Department of General and Digestive Surgery, Hôpital Saint-Antoine, Assistance Publique Hôpitaux de Paris, Sorbonne Université, 184 rue du Faubourg Saint-Antoine, 75012, Paris, France.
Insights
Postoperative peritonitis (POP) following gastrointestinal surgery is a serious complication. Aggressive surgical management is improving outcomes, and identifying risk factors like multiorgan failure helps tailor patient care.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Critical Care Medicine
Background:
- Postoperative peritonitis (POP) following gastrointestinal surgery presents significant morbidity and mortality.
- Current management strategies for POP lack clear consensus.
- This study aimed to detail surgical management and identify risk factors for POP outcomes.
Purpose of the Study:
- To report surgical management strategies for postoperative peritonitis (POP).
- To identify pre- and perioperative risk factors associated with morbidity and mortality in POP patients.
Main Methods:
- Retrospective analysis of 191 patients undergoing relaparotomy for POP between 2004 and 2013.
- Data collected included pre- and perioperative variables.
- Statistical analysis to identify predictors of morbidity and mortality.
Main Results:
- Anastomotic leakage was the most common cause of POP (66.5%).
- Overall mortality was 14%, with 40% occurring within 48 hours.
- Independent risk factors for mortality included ASA > 2, multiorgan failure (MOF), perioperative transfusion, and upper GI origin.
- Independent risk factors for morbidity included MOF, upper GI origin, and delayed extubation.
Conclusions:
- Mortality from POP, while significant, is decreasing due to aggressive surgical intervention.
- Identifying predictors of poor outcomes is crucial for optimizing management strategies.
- Effective surgical management and risk factor identification are key to improving POP patient outcomes.
Background:
Postoperative peritonitis (POP) following gastrointestinal surgery is associated with significant morbidity and mortality, with no clear management option proposed. The aim of this study was to report our surgical management of POP and identify pre- and perioperative risk factors for morbidity and mortality.
Methods:
All patients with POP undergoing relaparotomy in our department between January 2004 and December 2013 were included. Pre- and perioperative data were analyzed to identify predictors of morbidity and mortality.
Results:
A total of 191 patients required relaparotomy for POP, of which 16.8% required >1 reinterventions. The commonest cause of POP was anastomotic leakage (66.5%) followed by perforation (20.9%). POP was mostly treated by anastomotic takedown (51.8%), suture with derivative stoma (11.5%), enteral resection and stoma (12%), drainage of the leak (8.9%), stoma on perforation (8.4%), duodenal intubation (7.3%) or intubation of the leak (3.1%). The overall mortality rate was 14%, of which 40% died within the first 48 h. Major complications (Dindo-Clavien > 2) were seen in 47% of the cohort. Stoma formation occurred in 81.6% of patients following relaparotomy. Independent risk factors for mortality were: ASA > 2 (OR = 2.75, 95% CI = 1.07-7.62, p = 0.037), multiorgan failure (MOF) (OR = 5.22, 95% CI = 2.11-13.5, p = 0.0037), perioperative transfusion (OR = 2.7, 95% CI = 1.05-7.47, p = 0.04) and upper GI origin (OR = 3.55, 95% CI = 1.32-9.56, p = 0.013). Independent risk factors for morbidity were: MOF (OR = 2.74, 95% CI = 1.26-6.19, p = 0.013), upper GI origin (OR = 3.74, 95% CI = 1.59-9.44, p = 0.0034) and delayed extubation (OR = 0.27, 95% CI = 0.14-0.55, p = 0.0027).
Conclusion:
Mortality following POP remains a significant issue; however, it is decreasing due to effective and aggressive surgical intervention. Predictors of poor outcomes will help tailor management options.
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