Abstract
Secondary peritonitis of colorectal origin has considerable morbidity and mortality. Relaparotomies are frequently necessary in the course of the disease. The objective of this study was to evaluate several scores in terms of their predictive value, i.e. whether Mannheim Peritonitis Index (MPI), Acute Physiology And Chronic Health Evaluation (APACHE) II, or Colorectal Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity (CR-POSSUM) scores can predict relaparotomies. Charts of 147 patients treated for secondary peritonitis of colorectal origin were retrospectively reviewed, MPI, APACHE II, and CR-POSSUM scores were calculated, and groups of patients with or without relaparotomies were compared. Thirty-four percent of patients underwent one or more relaparotomies. Patients with relaparotomies showed a significantly higher APACHE II score than patients without relaparotomies (p = 0.004). MPI (p = 0.072) and CR-POSSUM score (p = 0.319) did not differ between the two groups. A high APACHE II score was also significantly associated with the need for a relaparotomy on demand (p <0.001), and for the combined outcome parameter relaparotomy and/or an interventional drainage (p = 0.046). Both other scores were not predictive for these outcomes. Overall in-hospital mortality was 21.8%. All three scores investigated were predictive for mortality. Sensitivity was 62.5%, 78.1%, and 75.0% for MPI, APACHE II score, and CR-POSSUM score, respectively. The Acute Physiology And Chronic Health Evaluation II score might be helpful in predicting the need for relaparotomies in patients with secondary peritonitis of colorectal origin.
Highlights
Secondary peritonitis of colorectal origin has considerable morbidity and mortality
As the need for a relaparotomy is closely related to the magnitude of the disease, we hypothesised that high Mannheim Peritonitis Index (MPI), Acute Physiology And Chronic Health Evaluation (APACHE) II, and CRPOSSUM scores could be correlated with the need for one or more relaparotomies
As the need for a relaparotomy is closely related to the magnitude of the disease, we investigated in this study whether high MPI, APACHE II, and CR-POSSUM scores might be correlated with the need for relaparotomies
Summary
Secondary peritonitis of colorectal origin has considerable morbidity and mortality. Due to a breach in the integrity of the colonic wall, significant contamination of the abdominal cavity occurs that cannot always be fully mastered during the first operation. The Acute Physiology And Chronic Health Evaluation (APACHE) II score was modeled as a general measure of severity of disease and to predict the in-hospital mortality of patients on intensive care units. The APACHE II score is calculated based on physiologic parameters, age, and a chronic health evaluation [2]. The ColoRectal Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (CR-POSSUM) was developed as a risk score dedicated to colorectal surgery in the United Kingdom [3], and has subsequently been evaluated for the United States as well [4]. Based on a physiological score and an operative severity score, the individual mortality risk is predicted [3]. The objective of the current study was to evaluate whether the MPI, APACHE II, Swiss Medical Weekly · PDF of the online version · www.smw.ch
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