Preoperative risk factors for mortality after relaparotomy: analysis of 254 patients

Introduction The aim of this work was to analyze preoperative mortality risk factors after relaparotomy for abdominal surgery in a unit of General Surgery at a University Hospital. Methods A total of 314 relaparotomies in 254 patients were performed between February 2004 and February 2008. We analyz...

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Bibliographic Details
Published in:Langenbeck's archives of surgery 2010-06, Vol.395 (5), p.527-534
Main Authors: Martínez-Casas, Isidro, Sancho, Juan J., Nve, Esther, Pons, Maria-José, Membrilla, Estela, Grande, Luis
Format: Article
Language:English
Subjects:
Abdominal Surgery
Cardiac Surgery
Chi-Square Distribution
Digestive System Surgical Procedures - mortality
Female
General Surgery
Gynecologic Surgical Procedures - mortality
Humans
Laparotomy - mortality
Logistic Models
Male
Medicine
Medicine & Public Health
Middle Aged
Original Article
Postoperative Complications - mortality
Reoperation
Risk Factors
Thoracic Surgery
Traumatic Surgery
Urologic Surgical Procedures - mortality
Vascular Surgery
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Summary:Introduction The aim of this work was to analyze preoperative mortality risk factors after relaparotomy for abdominal surgery in a unit of General Surgery at a University Hospital. Methods A total of 314 relaparotomies in 254 patients were performed between February 2004 and February 2008. We analyzed data about past medical history, first operation, as well as clinical and biochemical parameters previous to reoperation. Results Indications for relaparotomy were peritonitis, bleeding, abscess, exploratory laparotomy, and evisceration. Overall mortality was 22%. Mortality of the patients with a single relaparotomy was 20% vs. 44% if they were reoperated upon twice. Mortality was associated with age, past history of cardiovascular disease, active neoplasm, previous treatment with platelet anti-aggregant drugs, first surgery American Society of Anesthesia score, and the presence of an anastomosis. Preoperative data associated with mortality were the number of systemic inflammatory response syndrome criteria, suture dehiscense, ileus, positive blood cultures, mechanical ventilation, artificial nutrition, antibiotics or vasoactive drugs, tachycardia, and abnormal body temperature. High white blood cell count or bilirrubin levels and low albumin or prothrombin time were also associated with mortality. Multivariate logistic regression analysis isolated age ( P  = 0.02), abnormal body temperature ( P  = 0.02), and the need of mechanical ventilation ( P  = 0.004) as independent preoperative variables predictive for mortality after relaparotomy. Conclusions Advanced age, the presence of either fever or hypothermia, and the need of mechanical ventilation are preoperative risk factors associated with mortality after relaparotomy and should be considered when planning reintervention.
ISSN:1435-2443
1435-2451
DOI:10.1007/s00423-009-0538-0