BACKGROUND: Planned relaparotomy and relaparotomy on demand are two frequently employed surgical treatment strategies for patients with abdominal sepsis. METHODS: The available literature was evaluated to compare the efficacy of both surgical treatment strategies. A systematic search for studies comparing planned and on-demand relaparotomy strategies in adult patients with secondary peritonitis was employed. Studies were reviewed independently for design features, inclusion and exclusion criteria, and outcomes. The primary outcome measure was in-hospital mortality. RESULTS: No randomized studies were found; eight observational studies with a total of 1266 patients (planned relaparotomy, 286; relaparotomy on demand, 980) met the inclusion criteria and were included in the meta-analysis. These eight studies were heterogeneous on clinical and statistical grounds (chi2= 40.7, d.f. = 7, P < 0.001). Using a random-effects approach, the combined odds ratio for in-hospital mortality was 0.70 (95 per cent confidence interval 0.27 to 1.80) in favour of the on-demand strategy. CONCLUSION: The combined results of observational studies show a statistically non-significant reduction in mortality for the on-demand relaparotomy strategy compared with the planned relaparotomy strategy when corrected for heterogeneity in a random-effects model. Owing to the non-randomized nature of the studies, the limited number of patients per study, and the heterogeneity between studies, the overall evidence generated by the eight studies was inconclusive.
BACKGROUND: Planned relaparotomy and relaparotomy on demand are two frequently employed surgical treatment strategies for patients with abdominal sepsis. METHODS: The available literature was evaluated to compare the efficacy of both surgical treatment strategies. A systematic search for studies comparing planned and on-demand relaparotomy strategies in adult patients with secondary peritonitis was employed. Studies were reviewed independently for design features, inclusion and exclusion criteria, and outcomes. The primary outcome measure was in-hospital mortality. RESULTS: No randomized studies were found; eight observational studies with a total of 1266 patients (planned relaparotomy, 286; relaparotomy on demand, 980) met the inclusion criteria and were included in the meta-analysis. These eight studies were heterogeneous on clinical and statistical grounds (chi2= 40.7, d.f. = 7, P < 0.001). Using a random-effects approach, the combined odds ratio for in-hospital mortality was 0.70 (95 per cent confidence interval 0.27 to 1.80) in favour of the on-demand strategy. CONCLUSION: The combined results of observational studies show a statistically non-significant reduction in mortality for the on-demand relaparotomy strategy compared with the planned relaparotomy strategy when corrected for heterogeneity in a random-effects model. Owing to the non-randomized nature of the studies, the limited number of patients per study, and the heterogeneity between studies, the overall evidence generated by the eight studies was inconclusive.
Authors: Fatih Agalar; Erol Eroglu; Mahmut Bulbul; Canan Agalar; Omar Ridvan Tarhan; Mustafa Sari Journal: World J Surg Date: 2005-02 Impact factor: 3.352
Authors: Brent C Opmeer; Kimberly R Boer; Oddeke van Ruler; Johannes B Reitsma; Hein G Gooszen; Peter W de Graaf; Bas Lamme; Michael F Gerhards; E Philip Steller; Cecilia M Mahler; Huug Obertop; Dirk J Gouma; Patrick Mm Bossuyt; Corianne Ajm de Borgie; Marja A Boermeester Journal: Crit Care Date: 2010-05-27 Impact factor: 9.097
Authors: Diane A Schwartz; Xuan Hui; Catherine G Velopulos; Eric B Schneider; Shalini Selvarajah; Donald Lucas; Elliott R Haut; Nathaniel McQuay; Timothy M Pawlik; David T Efron; Adil H Haider Journal: J Trauma Acute Care Surg Date: 2014-01 Impact factor: 3.313