Predictors of relaparotomy for persisting intra abdominal infection in secondary peritonitis

Abstract

Background: Peritonitis is one of the commonest causes of acute abdomen in Ethiopia. One of the causes of high morbidity and mortality is persistent intraabdominal infection. The two essential approaches for managing post-op collection are laparotomy on-demand and planned Relaparotomy. Despite multiple studies, both have comparative mortality. This study aimed to identify clinical variables that are predictive of persistent intraabdominal infection. Methods: A retrospective study was conducted on patients who were operated on from Sept 2018 to April 2020 at two affiliated referral hospitals of AAU, college of Medicine; Yekatit 12 hospital Medical College and Minilik II referral Hospital. All of the patients were cases of secondary peritonitis. Clinical progress of the patients from admission to discharge/death was documented. Multiple preoperative and intraoperative variables were analyzed to develop the predictive clinical model. Results: Out of 172 laparotomy cases for secondary peritonitis, 40 (23.3%) required relaparotomy for postop collection. From Patients who developed postop collection, 45% of them were diagnosed after pus/Gi content leaked through the surgical wound. The mortality rate of patients who develop postop collection and undergone relaparotomy was 27.5 % and 4.5% for those without postop collection. Logistic regression identified 4 variables as having significant predictive value: Duration of illness more than 5 days, Systolic BP 1000 ml, and small bowel as a source of contamination. Overall prediction successes of the above model is 88.4% (sensitivity 53.3%, specificity 96.8%). Conclusion: Management of persistent intra-abdominal infection is challenging. We have identified 4 clinical variables that predict persistent intraabdominal infection requiring relaparotomy. These sets of variables can be a milestone for future validation study before being inserted in today to day clinical practice.