Abstract
Numerous patient-related clinical parameters and treatment-specific variables have been identified as causing or contributing to the severity of peritonitis. We postulated that a combination of clinical and surgical markers and scoring systems would outperform each of these predictors in isolation. To investigate this hypothesis, we developed a multivariable model to examine whether survival outcome can reliably be predicted in peritonitis patients treated with open abdomen. This single-center retrospective analysis used univariable and multivariable logistic regression modeling in combination with repeated random sub-sampling validation to examine the predictive capabilities of domain-specific predictors (i.e., demography, physiology, surgery). We analyzed data of 1,351 consecutive adult patients (55.7% male) who underwent open abdominal surgery in the study period (January 1998 to December 2018). Core variables included demographics, clinical scores, surgical indices and indicators of organ dysfunction, peritonitis index, incision type, fascia closure, wound healing, and fascial dehiscence. Postoperative complications were also added when available. A multidomain peritonitis prediction model (MPPM) was constructed to bridge the mortality predictions from individual domains (demographic, physiological and surgical). The MPPM is based on data of n = 597 patients, features high predictive capabilities (area under the receiver operating curve: 0.87 (0.85 to 0.90, 95% CI)) and is well calibrated. The surgical predictor “skin closure” was found to be the most important predictor of survival in our cohort, closely followed by the two physiological predictors SAPS-II and MPI. Marginal effects plots highlight the effect of individual outcomes on the prediction of survival outcome in patients undergoing staged laparotomies for treatment of peritonitis. Although most single indices exhibited moderate performance, we observed that the predictive performance was markedly increased when an integrative prediction model was applied. Our proposed MPPM integrative prediction model may outperform the predictive power of current models.
Highlights
Primary and secondary infectious peritonitis pose major challenges for clinicians globally [1, 2]
We found that patient age was the strongest predictor of the demographic variables, with an odds ratio (OR) of 1.04 (1.02–1.06, 95% CI)
We demonstrate that integrative modeling using available information about demographics, disease severity, physiological parameters, and medical interventions can outperform previous prediction models, highlighting the importance of our integrative (MPPM model) approach
Summary
Primary and secondary infectious peritonitis pose major challenges for clinicians globally [1, 2]. There is some evidence of favorable outcomes when using staged relaparotomies and repeated lavage in selected cohorts [1, 4, 5]. This approach is Extended author information available on the last page of the article accepted as a standard procedure for the septic abdomen [6, 7]. Following meticulous exploration of the abdomen, thorough cleansing with copious fluids, and surgical repair of lesions, the abdominal cavity is left open and the small bowel is protected with an intestine bag. To minimize abdominal wall retraction during open abdomen treatment, a mesh is sutured into the dorsal aspect of the rectus muscle
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