Retrospective Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Crit Care Med. Feb 4, 2017; 6(1): 48-55
Published online Feb 4, 2017. doi: 10.5492/wjccm.v6.i1.48
Risk factors for mortality in postoperative peritonitis in critically ill patients
Yoann Launey, Benjamin Duteurtre, Raphaëlle Larmet, Nicolas Nesseler, Audrey Tawa, Yannick Mallédant, Philippe Seguin
Yoann Launey, Benjamin Duteurtre, Raphaëlle Larmet, Nicolas Nesseler, Audrey Tawa, Yannick Mallédant, Philippe Seguin, Anesthésie Réanimation 1, Centre Hospitalier Universitaire de Rennes, F-35000 Rennes, France
Author contributions: Launey Y, Mallédant Y and Seguin P contributed to study design/planning; Launey Y, Duteurtre B, Nesseler N, Tawa A, Mallédant Y and Seguin P contributed to study conduct; Launey Y, Duteurtre B, Nesseler N, Mallédant Y and Seguin P contributed to data analysis; Launey Y, Duteurtre B, Mallédant Y and Seguin P contributed to writing paper; all authors contributed to revising paper.
Institutional review board statement: This study was reviewed and approved by the ethics committee of Rennes University hospital.
Informed consent statement: The ethics committee waived informed consent.
Conflict-of-interest statement: None.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Philippe Seguin, MD, PhD, Professor, Anesthésie Réanimation 1, Centre Hospitalier Universitaire de Rennes, Inserm U991, F-35000 Rennes, France. philippe.seguin@chu-rennes.fr
Telephone: +33-2-99289371 Fax: +33-2-99282421
Received: August 19, 2016
Peer-review started: August 23, 2016
First decision: September 28, 2016
Revised: November 14, 2016
Accepted: December 7, 2016
Article in press: December 9, 2016
Published online: February 4, 2017
Processing time: 155 Days and 20.6 Hours
Abstract
AIM

To identify the risk factors for mortality in intensive care patients with postoperative peritonitis (POP).

METHODS

This was a retrospective analysis using a prospective database that includes all patients hospitalized in a surgical intensive care unit for POP from September 2006 to August 2011. The data collected included demographics, comorbidities, postoperative severity parameters, bacteriological findings, adequacy of antimicrobial therapy and surgical treatments. Adequate source control was defined based on a midline laparotomy, infection source control and intraoperative peritoneal lavage. The number of reoperations needed was also recorded.

RESULTS

A total of 201 patients were included. The overall mortality rate was 31%. Three independent risk factors for mortality were identified: The Simplified Acute Physiological II Score (OR = 1.03; 95%CI: 1.02-1.05, P < 0.001), postoperative medical complications (OR = 6.02; 95%CI: 1.95-18.55, P < 0.001) and the number of reoperations (OR = 2.45; 95%CI: 1.16-5.17, P = 0.015). Surgery was considered as optimal in 69% of the cases, but without any significant effect on mortality.

CONCLUSION

The results from the large cohort in this study emphasize the role of the initial postoperative severity parameters in the prognosis of POP. No predefined criteria for optimal surgery were significantly associated with increased mortality, although the number of reoperations appeared as an independent risk factor of mortality.

Keywords: Mortality; Postoperative peritonitis; Risk factors; Surgery

Core tip: This retrospective study performed from a prospective data base analysed the risk factor for mortality in 201 patients admitted for postoperative peritonitis (POP) in a surgical intensive care unit. Three independent risk factors for mortality were identified: The Simplified Acute Physiological II Score, postoperative medical complications and the number of reoperations. This study emphasizes the role of the initial postoperative severity parameters in the prognosis of POP. No predefined criteria for optimal surgery were significantly associated with increased mortality, although the number of reoperations appeared as an independent risk factor of mortality.