Demand vs Planned Relaparotomy for Peritonitis: Is It Ok to Wait?
Demand vs Planned Relaparotomy for Peritonitis: Is It Ok to Wait?
van Ruler O, Mahler CW, Boer KR, et al.
JAMA 2007;298:865-873.
Patients who undergo surgery because of severe peritonitis often require reoperation. The aim of this study was to determine which of the following is a better approach: a planned or an on-demand reoperation (performed only if the patient's condition deteriorates). To answer this question, the authors conducted a randomized clinical trial involving 232 Dutch patients (116 planned reoperations, 116 on-demand). There was no significant difference in either mortality or morbidity, but 94% of the planned group underwent additional surgeries compared to only 42% of the on-demand group (P ≤ .001). Median hospital stay was also shorter in the on-demand group: 27 vs 35 days (P = .008).
Managing surgical patients with peritonitis accompanied by complicated abdominal pathology has always been a problem because a high proportion of patients will need more than a single operation. This carefully performed randomized trial carried out in a challenging group of patients demonstrates that although there is no difference in mortality or morbidity, fewer reoperations were performed in the on-demand group, resulting in significantly shorter hospitalization and a reduction in total costs.
Abstract
van Ruler O, Mahler CW, Boer KR, et al.
JAMA 2007;298:865-873.
Patients who undergo surgery because of severe peritonitis often require reoperation. The aim of this study was to determine which of the following is a better approach: a planned or an on-demand reoperation (performed only if the patient's condition deteriorates). To answer this question, the authors conducted a randomized clinical trial involving 232 Dutch patients (116 planned reoperations, 116 on-demand). There was no significant difference in either mortality or morbidity, but 94% of the planned group underwent additional surgeries compared to only 42% of the on-demand group (P ≤ .001). Median hospital stay was also shorter in the on-demand group: 27 vs 35 days (P = .008).
Managing surgical patients with peritonitis accompanied by complicated abdominal pathology has always been a problem because a high proportion of patients will need more than a single operation. This carefully performed randomized trial carried out in a challenging group of patients demonstrates that although there is no difference in mortality or morbidity, fewer reoperations were performed in the on-demand group, resulting in significantly shorter hospitalization and a reduction in total costs.
Abstract