Revista Colombiana de Cirugía
versión impresa ISSN 2011-7582
ORDONEZ DELGADO, Carlos Alberto et al. Mortality and morbidity of secondary peritonitis with planned relaparotomy. rev. colomb. cir. [online]. 2006, vol.21, n.2, pp. 124-132. ISSN 2011-7582.
Introduction: The ideal treatment of severe complicated secondary peritonitis (SCSP) remains unclear. The purpose of this paper is the presentation of the clinical results of the surgical policy of planned relaparotomy in the management of SCSP. Material and methods: All patients with SCSP were managed with planned relaparotomy in the period 1995-2004; the abdominal wall was closed once the infectious process had been controlled. The main outcome was hospital mortality. After the year 2000 we registered descent of the rate of relaparotomy because the policy change to planned intervention, which restricted the number of reinterventions. A multivariate analysis was carried out. The hospital committee of bioethics approved the implementation of the study. Results: The study population included 267 patients with average age of 52.2 years; 62.5 were male; mean ICU stay was15.8 days, the rate of planned relaparotomies was 4 ± 3 with a median of 3. The global mortality rate was 19.9%; before the year 2000 the rate was 28.4%, and after the year 2000 the rate came down to 14.5%. The multivariate analysis showed that relaparotomy was not an independent predictor of mortality (OR: 1.98, CI 95% 0.78-3.41, p=0.3). but age >50 years, shock, and APACHE II score >25 were independent predictors. Most common complications were intestinal fistulae (15.3%), septic shock (54%), and ARDS (30%). Conclusion: Global mortality rate in patients with severe secondary peritonitis was less than 20%. The independent predictors of mortality in the study group were age>50 years, shock, and APACHE II score >25.
Palabras llave : peritonitis; sepsis; laparotomy; postoperative complications; intensive cares.