The factors effecting mortality in relaparotomies

Relaparotomy means new abdominal operation or operations in 60 days after primary operation and cause high mortality. İn this study we aimed to study independent risks factors effecting mortality after relaparotomy.We planed the study in 114 patients undergone relaparomies among 6125 patients whom undergone abdominal operations between January 2002- July 2007 at Dicle University Hospital department of general surgery. Datas studied were included age, gender, present systemic diseases, organs operated during first operation, timing of operation (emergency or elective), hospitals the first operation caried on ( ours or others), blood transfusion after first operation if made, and time passed between first operation and relaparotomy. Acute Physiology and Chronic Health Evaluation score (APACHE II) applied on the day of relaparotomies. Independent risk factors effecting mortality defined with multivariate logistic regression analyses from factors with p< 0.2 on univariate analyses.114 patients among 6125 undergone abdominal surgery were undergone 131 relaparotomies. The mean of relaparomies was 1.15; mortality rate was 48.2% (55/114) in patients undergone relaparotomies. Seventy-five (65,8%) patients were male and 39 (34.2%) female. The mean age was 46.06±19.98 years (15-84). The mortality rate was 68.6% (35/51) in 51 (44.7%) patients over 50 years old and 31.7% (20/63) in 63 (55.3%) patients under 50 years old. Mortality rate was 70.6% (24/34) in patients with systemic diseases. All relapatomies were done in emergency conditions. The mean APACHE II score was 19.23±8.06 (2-44) in 114 patients. The mortaity rate was 75.0% (45/60) in patients with APACHE II higher than 20 and 18.5% (10/54) less than 20.Relapatomies most commonly done after lower gastrointestinal surgical operations (50.0%, 57/114); mortality rate of relaparomies were 45.6% (26/57) after lower gastrointestinal surgical operations, 52.6% (10/19) in patients with multiple organs pathologies, 68.7% (11/16) after hepatobilier pathologies, and 40.0% (4/10) after upper gastrointestinal surgical operations. The most common reason for relaparomy was leakage from intestinal repair or anastomotic sites (29.8%, 34/114). Mortality rate of these patients was 50.0% (17/34) and 39.1% (9/23) in patients with hemorrhagy, 26.3% (5/19) after intraabdominal infections and 76.9% (10/13) after intestinal necrosis. İntestinal necrosis and intraabdominal infections effected mortality significantly with p=0.038 and p=0.036 respectively. Multiple relaparatomies were made in 15 (13.2%) patients due to lack of controling complications. Mortality rates in single and multiple relaparotomies were 44.4% (44/99) and 73.3% (11/15) respectively. The most common cause of mortality was sepsis and multiple organs failure (45.4%, 25/55). The mean time passed between first operation and relaparotomies was 7.87±7.70 (0-60) days. The mean of hospital stays was 24.32±18.69 (1-91) days.Risk factors, which was selected from univariate analyses, old age, presence of systemic diseases, presence of infections, relaparatomies if done frequently, andAPACHE II score over 20 were evaluated with multivariate analyses and just APACHE II score over 20 (p<0.0001) and old age (p=0.017) were found independent risk factors effecting mortality significantly.Apropriate attention during first operation and apropriate time for treating postoperative complication would decrease the need for relaparotomies and mortality. Hovewer, not time losing relaparotomy would save life in necessary cases. APACHE II score over 20 and old age were found independed risk factors effecting mortality in multivariated analyses.