Predictors of relaparotomy after nontrauma emergency general surgery with initial fascial closure

BackgroundRelaparotomy after emergency surgery for nontrauma intraabdominal catastrophes (NTIAC) is morbid. Our objective was to identify patients who likely will need on-demand relaparotomy after surgery for NTIAC.MethodsA retrospective chart review of patients from 1998 to 2008 identified cases of NTIAC surgery with fascial closure. Demographics, comorbidities, intraoperative findings, morbidity, and mortality were analyzed. Relaparotomy was defined as any return to the operating room with surgical re-entry of the abdominal cavity.ResultsA total of 129 patients underwent NTIAC surgery with fascial closure. Twenty-nine patients (22%) required relaparotomy and 100 patients (78%) did not. Multivariate analysis identified the following predictors of relaparotomy: peripheral vascular disease (P = .04), alcohol abuse (P = .02), body mass index of 29 kg/m2 or greater (P = .04), the finding of any ischemic bowel (P = .02), and operating room latency of 60 hours or longer (P = .01). Patients with 2 or more of these predictors had a 55% risk of relaparotomy whereas patients with fewer than 2 of these predictors had a 9% risk (P < .001).ConclusionsPatients whose fascia is closed during NTIAC surgery do worse when they require relaparotomy. We have identified preoperative and intraoperative predictors that may help identify patients at high risk of on-demand relaparotomy.