Association of VA Surgeons Predictors of relaparotomy after nontrauma emergency general surgery with initial fascial closure Jerry J. Kim, B.S., Mike K. Liang, M.D.*, Anuradha Subramanian, M.D., Courtney J. Balentine, M.D., Shubhada Sansgiry, Ph.D., Samir S. Awad, M.D., M.P.H. Michael E. DeBakey Department of Surgery, Baylor College of Medicine, MED VAMC, OCL (112), 2002 Holcombe Blvd., Houston, TX 77030, USA Abstract BACKGROUND: Relaparotomy after emergency surgery for nontrauma intraabdominal catastrophes (NTIAC) is morbid. Our objective was to identify patients who likely will need on-demand relapa- rotomy after surgery for NTIAC. METHODS: A 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. RESULTS: A 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/m 2 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). CONCLUSIONS: Patients 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. Published by Elsevier Inc. KEYWORDS: Relaparotomy; Open abdomen; Temporary abdominal closure; Predictors; Emergency laparotomy; Dehiscence Patients with nontrauma intraabdominal catastrophe (NTIAC) undergoing emergent laparotomy encounter a grim progno- sis. Recently published data in patients undergoing emer- gency general surgery have shown mortality rates approach- ing 9% in this population. 1 Further, a significant proportion of these patients require on-demand relaparotomy because of an unforeseen complication or deterioration in clinical status. When relaparotomy is necessary, mortality rates in- crease to as high as 22% to 51%. 2–5 Recognition of patients at high risk of relaparotomy after emergency surgery would have significant clinical value. However, there is currently a dearth of evidence regarding factors prognostic of impending relaparotomy after NTIAC surgery. 6 The objective of this retrospective cohort study was to identify predictors of on-demand relaparotomy after emergency surgery for NTIAC in patients receiving initial closure of the fascia. To identify clinically relevant predic- tors, emphasis was placed on preoperative and intraopera- tive variables that would be available to the surgeon before abdominal closure of the initial emergency surgery. * Corresponding author. Tel.: +1-713-794-8017; fax: +1-713-794- 7352. E-mail address: ml3@bcm.edu Manuscript received April 15, 2011; revised manuscript June 27, 2011 0002-9610/$ - see front matter Published by Elsevier Inc. doi:10.1016/j.amjsurg.2011.06.023 The American Journal of Surgery (2011) 202, 549 –552