The decision to perform a relaparotomy in patients with secondary peritonitis is based on clinical judgment, with inherent variability among surgeons.
Dr Marja Boermeester and colleagues from the Netherlands reviewed the literature on prognostic variables for ongoing abdominal infection.
Predictive variables for positive findings at relaparotomy can offer more objective criteria to perform a relaparotomy in patients with secondary peritonitis.
The investigative team searched multiple databases.
The team searched for studies assessing the prognostic value of clinical variables predicting outcome of relaparotomy or general outcomes with secondary peritonitis.
Data on the methodologic quality of the study as well as statistical strength of predictors and validity of individual variables were extracted and scored.
The investigators calculated a cumulative score from these 3 scores, and the variables were ranked.
|The variables included age and bilirubin levels|
|World Journal of Surgery|
The team included a total of 37 of 197 retrieved articles for final assessment.
The median score for methodologic quality of individual articles was 36.
After calculation of the combined scores, 76 individual variables were identified from which the top 10 were eventually selected.
These variables included age, concomitant disease, upper gastrointestinal source of peritonitis, and generalized peritonitis.
The investigators also identified elimination of the focus, bilirubin, creatinine, lactate, PaO2/FiO2 ratio, and albumin.
This set of variables proved to be moderately predictive for positive findings during relaparotomy in a retrospective cohort of 219 peritonitis patients.
Dr Boermeester's team concludes, “This review generated a hierarchy of published variables that could play a role in the decision to perform a relaparotomy in patients with secondary peritonitis.”
“The top 10 ranked 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.”
“However, improvement in overall predictive strength of a set of variables in such a score is needed.”