• Dominik Rüttinger, David Kuppinger, Manuela Hölzwimmer, Sabrina Zander, Markus Vilsmaier, Helmut Küchenhoff, Karl-Walter Jauch, and Wolfgang H Hartl.
• Department of Surgery, Campus Grosshadern, Ludwig-Maximilians-University Munich, Marchioninistrasse 15, Munich, Germany.
• Am. J. Surg. 2012 Jul 1;204(1):28-36.

BackgroundDuration of surgical therapy and the number of surgical revisions performed to control the focus may be important prognostic variables. Association of such time-dependent therapies with survival, however, has not yet been studied.MethodsWe analyzed survival times of adult patients (n = 283) who were suffering from secondary peritonitis and associated organ failure. Cox-type additive hazard regression models were used to analyze associations of surgical variables with survival time.ResultsSeventy-two patients (25.4%) survived the period of excess mortality after intensive care unit admission. A total of 79.5% of the 283 patients required one or more surgical revisions. Besides the underlying disease and disease severity at intensive care unit admission, there was a nonlinear smoothed association between a poorer outcome and the duration of surgical therapy, and the number of surgical revisions. For the latter, hazard ratios increased sharply between 1 and 5 revisions, and remained largely constant later on.ConclusionsIn critically ill patients with peritonitis, a long therapy and the necessity for a high number of reoperations is related inversely to acute survival.Copyright © 2012 Elsevier Inc. All rights reserved.

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