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World J. Surg. 28, 137141, 2004DOI: 10.1007/s00268-003-7067-8WORLDJournal ofSURGERY 2004 by the Societe
Internationale de ChirurgieRelaparotomy for Suspected Intraperitoneal Sepsis after Abdominal SurgeryRobert R. Hutchins, M.S.,1 M. Paul Gunning, M.B.,2 D. Nuala Lucas, M.B.,2 Timothy G. Allen-Mersh, M.D.,1
Neil C. Soni, M.D.21Department of Surgery, Faculty of Medicine, Imperial College of Science, Technology and Medicine, London, UK2Magill Department of Anaesthetics, Chelsea and Westminster Hospital, 369 Fulham Road, London, SW10 9NH UKPublished Online: January 8, 2004Abstract. Relaparotomy may be beneficial in patients developing intraperitoneal sepsis after abdominal procedures. We determined whether joint
clinical assessment by intensivist and surgeon (clinician assessment) identified patients with surgically correctable intraperitoneal sepsis. We also
assessed the effect of patient age and sex, disease presentation and severity,
interval to relaparotomy, and the number of relaparotomies on survival
after relaparotomy. Data on clinical, laboratory, and radiologic abnormalities prior to relaparotomy, relaparotomy findings, and in-hospital survival
were prospectively collected on a general hospital intensive care unit (ICU)
database between January 1997 and January 2002. Altogether, 65 of 1482(4.4%) patients admitted to the ICU after abdominal surgery underwent
relaparotomy at a median of 5 days after the initial procedure. There was
an 83% probability of identifying surgically treatable sepsis and 43% inhospital mortality. Abdominal imaging contributed accurate information
in 50% of cases where clinician assessment was uncertain. Patient age and
multiorgan failure prior to relaparotomybut not urgency of initial laparotomy or the acute physiology and chronic health evaluation (APACHE II)
score prior to relaparotomy, interval to relaparotomy, or number of relaparotomiesaffected the outcome. Clinician assessment after abdominal
surgery had a high probability of predicting intraperitoneal sepsis at relaparotomy. The 43% mortality after relaparotomy was unlikely to be
greater than with nonoperative treatment of intraabdominal sepsis, but the
78% mortality after relaparotomy in patients older than 75 years of age
raised doubts about this approach in the elderly. The identification of intraperitoneal sepsis and performance of relaparotomy earlier after the initial abdominal surgery might reduce the high rate (60%) of multiorgan
failure prior to relaparotomy and improve survival after it.Intraabdominal sepsis after abdominal surgery is associated with a
mortality rate of 50% to 80% [14] among patients requiring intensive care unit (ICU) admission and is responsible for approximately
13% of ICU admissions [5]. Studies relying on predicted mortality