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World Journal of Surgery

, Volume 42, Issue 11, pp 3589–3598 | Cite as

Postoperative Peritonitis After Digestive Tract Surgery: Surgical Management and Risk Factors for Morbidity and Mortality, a Cohort of 191 Patients

  • Thierry Bensignor
  • Jérémie H. Lefevre
  • Ben Creavin
  • Najim Chafai
  • Thomas Lescot
  • Thévy Hor
  • Clotilde Debove
  • François Paye
  • Pierre Balladur
  • Emmanuel Tiret
  • Yann Parc
Original Scientific Report

Abstract

Background

Postoperative peritonitis (POP) following gastrointestinal surgery is associated with significant morbidity and mortality, with no clear management option proposed. The aim of this study was to report our surgical management of POP and identify pre- and perioperative risk factors for morbidity and mortality.

Methods

All patients with POP undergoing relaparotomy in our department between January 2004 and December 2013 were included. Pre- and perioperative data were analyzed to identify predictors of morbidity and mortality.

Results

A total of 191 patients required relaparotomy for POP, of which 16.8% required >1 reinterventions. The commonest cause of POP was anastomotic leakage (66.5%) followed by perforation (20.9%). POP was mostly treated by anastomotic takedown (51.8%), suture with derivative stoma (11.5%), enteral resection and stoma (12%), drainage of the leak (8.9%), stoma on perforation (8.4%), duodenal intubation (7.3%) or intubation of the leak (3.1%). The overall mortality rate was 14%, of which 40% died within the first 48 h. Major complications (Dindo–Clavien > 2) were seen in 47% of the cohort. Stoma formation occurred in 81.6% of patients following relaparotomy. Independent risk factors for mortality were: ASA > 2 (OR = 2.75, 95% CI = 1.07–7.62, p = 0.037), multiorgan failure (MOF) (OR = 5.22, 95% CI = 2.11–13.5, p = 0.0037), perioperative transfusion (OR = 2.7, 95% CI = 1.05–7.47, p = 0.04) and upper GI origin (OR = 3.55, 95% CI = 1.32–9.56, p = 0.013). Independent risk factors for morbidity were: MOF (OR = 2.74, 95% CI = 1.26–6.19, p = 0.013), upper GI origin (OR = 3.74, 95% CI = 1.59–9.44, p = 0.0034) and delayed extubation (OR = 0.27, 95% CI = 0.14–0.55, p = 0.0027).

Conclusion

Mortality following POP remains a significant issue; however, it is decreasing due to effective and aggressive surgical intervention. Predictors of poor outcomes will help tailor management options.

Notes

Authors’ contribution

TB, NC, TL, TH and CD collected data. TB, JHL, FP, PB, ET and YP interpreted the data. TN, JHL and BC analyzed the data. TB, JHL, BC and YP drafted the manuscript. NC, TL, TH, CD, FP, PB and ET revised the manuscript. All authors finally approved this manuscript. All authors are accountable for all aspects of the work.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no Conflict of interest.

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Copyright information

© Société Internationale de Chirurgie 2018

Authors and Affiliations

  • Thierry Bensignor
    • 1
  • Jérémie H. Lefevre
    • 1
  • Ben Creavin
    • 3
  • Najim Chafai
    • 1
  • Thomas Lescot
    • 2
  • Thévy Hor
    • 1
  • Clotilde Debove
    • 1
  • François Paye
    • 1
  • Pierre Balladur
    • 1
  • Emmanuel Tiret
    • 1
  • Yann Parc
    • 1
  1. 1.Department of General and Digestive Surgery, Hôpital Saint-Antoine, Assistance Publique Hôpitaux de ParisSorbonne UniversitéParisFrance
  2. 2.Department of Surgical Intensive Care, Hôpital Saint-Antoine, Assistance Publique Hôpitaux de ParisSorbonne UniversitéParisFrance
  3. 3.Department of Colorectal SurgerySt Vincent’s University HospitalDublin 4Ireland

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