The timing of relaparotomy and its influence on prognosis. A 10 year survey.

Review of 3,680 abdominal operations performed in our department during a 10 year period revealed that 95 patients (2.6 percent) required relaparotomy because of surgical complications during the same hospitalization. Of these, 37 patients died, a mortality of 38 percent, which is approximately 10-fold that for similar operations in which reintervention was not necessary. The mortality was greater in male patients and was very high (64 percent) in those over the age of 70 years. The most common complication necessitating relaparotomy was peritonitis (0.9 percent of the total series), followed by intestinal obstruction (0.8 percent) and wound disruption (0.7 percent). The frequency of bleeding requiring reoperation was low (0.1 percent). Intestinal operations were associated with the highest incidence of complications (6.2 percent), followed by gastric operations (4 percent). Assessment of the time interval between the development of the surgical complication and reoperation in each case indicated that there had been an unjustifiably long delay in reaching the correct diagnosis, in performing reoperation or both in 26 percent of this series (40 percent of the cases of peritonitis). This delay was usually greater with early than with relatively later complications. However, our findings failed to support a detrimental effect of this delay and even showed a tendency toward better results and a lower mortality when conservative treatment was prolonged before reoperation was performed.