Quality of life after severe bacterial peritonitis and infected necrotizing pancreatitis treated with open management of the abdomen and planned re-operations

Objective: To determine quality of life after severe bacterial peritonitis and infected necrotizing pancreatitis treated with open management of the a bdomen and planned re-operations. Design: Retrospective chart review. Setting. University hospital intensive care unit, general wards, and outpat ient department. Patients. Forty-one patients who survived severe bacterial peritonitis and infected necrotizing pancreatitis treated with open management of the abdom en and planned re-operations. Interventions, None. Measurements and Main Results. Over a period of 7 yrs, 95 patients underwen t open management of the abdomen and planned re-operations for severe bacte rial peritonitis and infected necrotizing pancreatitis. Thirty-nine patient s died during the initial intensive care unit stay and 12 as a result of no nperitonitis-related systemic diseases after discharge. Four patients were lost or excluded from final analysis. Long-term morbidity and quality of li fe using Karnofsky and Rankin scores at discharge and at follow-up at least 1 yr after discharge (mean: 4 yrs) and the Sickness Impact Profile (SIP) w ere determined. The remaining 41 patients reviewed showed significant long- term morbidity, including dysfunction of the abdominal wall resulting from herniation, persistent polyneuropathy, and mental disorders needing psychia tric support. Patients having persistent polyneuropathy and, to a lesser ex tent, mental disorders, showed significantly lower Karnofsky, higher Rankin , and higher SIP scores. After discharge, performance status of patients im proved significantly, as shown by higher Karnofsky and lower Rankin scores, and, because Karnofsky and Rankin scores are closely related to SIP scores , higher SIP scores. Especially in measuring quality of life in terms of so cial and role management, assessment of the SIP proved to have additional v alue. Conclusions: About three-quarters of patients who survive open management o f the abdomen and planned re-operations for severe bacterial peritonitis an d infected necrotizing pancreatitis regain a good quality of life. Some pat ients, especially those who suffer from persistent polyneuropathy and menta l disorders, show restrictions in daily life.