Impact of relaparotomy in patients with abdominal sepsis

Abstract

Abstract Background This study determined whether relaparotomy has a positive or negative effect on prognostic scoring systems. Methods Between April 1995 and January 1997, 46 patients with abdominal sepsis were treated. The diagnosis of abdominal sepsis was defined as meeting the Bone criteria for sepsis before operation, in combination with infection of the abdomen proven by laparotomy. After the first laparotomy there were 41 relaparotomies in these 46 patients. From 2 days before to 3 days after the relaparotomy, data were collected to compile the Acute Physiology and Chronic Health Evaluation (APACHE) III and Multiple Organ Failure (MOF) scores. The scores were compared before and after relaparotomy, and were also compared between patients who had a recurrent infection in the abdomen and those who did not. Results During 41 relaparotomies, 16 patients were found to have a pus collection. Of these clinical infections only 11 had a positive culture. Overall the APACHE III and MOF scores were not significantly different before and after operation. In patients with clinical infection there was also no difference pre and post operative. The same applied for patients with and without positive intraabdominal cultures. Conclusion Relaparotomy in patients with abdominal sepsis did not have a negative effect on prognosis within a few days after reoperation. The authors did not find any reason to use APACHE III or MOF scoring as an indication for relaparotomy.