Reoperation for sepsis.

Abstract

A retrospective study of 50 patients undergoing reoperation for sepsis was performed to evaluate the ability of commonly available clinical and laboratory tests to predict the findings at reoperation and the outcome after operation. The influence of multiple organ failure on these parameters was also studied. No laboratory finding helped to predict operative findings. Computed tomographic scanning (80% accurate) was the most helpful radiographic procedure. A low total lymphocyte count and a high serum creatinine level both predicted a fatal outcome. No single organ failure or combination predicted a positive reexploration. Infection was found in 75 per cent of patients with multiple organ failure and 79 per cent of patients who did not have this syndrome. Patients having three-organ failure did have a significantly higher mortality. The mortality of a negative reexploration was 18.2 per cent, slightly lower than the 28.2 per cent mortality of patients with a positive exploration. No patient without organ failure died. The authors conclude that laboratory tests are not helpful in predicting the presence of infection on reexploration, that the decision to reoperate is one based primarily on clinical judgment, and that if reoperation is performed before the development of organ failure, the risk associated with a negative exploration is worth taking.