Clinical Predictors of Ongoing Infection in Secondary Peritonitis: Systematic Review

Abstract

This review generated a hierarchy (weighted ranking) of published variables that could play a role in the decision to perform a relaparotomy in patients with secondary peritonitis. The top sixtile of ranked variables (10 variables) showed promising results in the discrimination between patients having a positive and negative relaparotomy when tested on a peritonitis patient database. This ranking of variables provides evidence for potential inclusion of variables in future predictive scores, although improvement in overall predictive strength of a set of variables in such a score is needed.

Decision Making for Relaparotomy in Secondary Peritonitis

“…The 21 individual variables listed in the survey were identified in a review of the literature on 76 possible parameters of ongoing abdominal infection [20]. The 21 listed variables were: age, sex, comorbidity, nutritional state, leukocyte count at time of emergency laparotomy (5 patient-related variables); localization of the infectious focus, etiology, type of contamination, extent of contamination, time of symptoms to index operation, acute physiology and chronic health evaluation (APACHE) II score [21], Mannheim Peritonitis Index (MPI) [22] (7 disease-related variables); successful elimination of infectious focus (source control), operative lavage, operating time, operative blood loss, abdominal drains in situ, diverting or/and end enterostomy present, primary anastomosis, and primary abdominal closure (9 operation-related variables).…”

Comparison of On-Demand vs Planned Relaparotomy Strategy in Patients With Severe Peritonitis

“…5,17,29,[31][32][33][34][35][36] However, results in the literature are inconclusive and the majority of studies predict disease outcome (mortality) of sepsis rather than positive findings at relaparotomy in secondary peritonitis. 14,20,[37][38][39][40][41][42] In attempt to guide decision making for relaparotomy and enhance timing of relaparotomy in the on-demand group within this trial, we prespecified the main criteria for necessity of relaparotomy as lack of clinical improvement or clinical deterioration using a quantified method (the Multiple Organ Dysfunction Score).…”

Causas de reintervenciones quirúrgicas por complicación postoperatoria en pacientes de una unidad de cuidados intensivos quirúrgicos sometidos a cirugía abdominal.

“…Los factores de riesgo para reintervención como edad mayor de 51 años, peritonitis, no eliminación del foco infeccioso; albúmina y PaO2/FiO2 disminuidos; y creatinina y lactato elevados (11,12), se encontraron presentes en la mayoría de nuestros pacientes.…”