Comparative analysis of outcome predictors in patients with postoperative peritonitis depending on the method of surgical treatment – relaparotomy on demand vs vacuum-assisted laparostomy

Abstract

Background: Secondary postoperative diffuse peritonitis (SPDP) is one of the most severe complications of elective and emergency surgical interventions associated with a high mortality rate. To date, no optimal tactics of surgical treatment of SPDP has been developed.Objective: The analysis of independent predictors of outcome depending on the method of surgical treatment – relaparotomy ondemand (RD) or vacuum-assisted laparostomy (VAL).Material and methods: The study included 141 adult patients, male and female in the period from January 2014 to December 2020: group I (n = 63) – patients who received VAL method; group II (n = 78) – RD method. The method of multivariate logistic regression analysis was used to calculate the independent effects of potential predictor variables on the treatment outcome.Results: The following independent predictors of treatment outcome in the RD group were identified: age, duration of hospital stay, number of relaparotomies, APACHE II score, Björck classification grade 1C at the 1st sanitation, bacteremia, Clavien–Dindo complications class 3a and 4a. For the VAL group: conversion of surgical tactics and bacteremia.Conclusion: In patients with SPDP in the presence of risk factors for unfavorable outcomes, the use of VAL with staged sanitation of the abdominal cavity is indicated.

Keywords

• postoperative peritonitis
• secondary peritonitis
• vacuum therapy
• laparostomy
• open abdomen
• relaparotomy on demand
• outcome predictors