Clinical Features and Outcome of Postoperative Peritonitis Following Bariatric Surgery

BACKGROUND: We assessed the clinical features and outcome of morbidly obese patients admitted to the intensive care unit (ICU) for management of postoperative peritonitis (POP) following bariatric surgery (BS). METHODS: In a prospective, observational, surgical ICU cohort, we compared the clinical features, empiric antibiotic therapy, and prognosis of BS patients with those developing POP after conventional surgery (cPOP). RESULTS: Overall, 49 BS patients were compared to 134 cPOP patients. BS patients were younger (45 ± 10 versus 63 ± 16 years; p < 0.0001), had lower rates of fatal underlying disease (39 vs 64 %; p = 0.002), and the same SOFA score at the time of reoperation (8 ± 4 vs 8 ± 3; p = 0.8) as the cPOP patients. BS patients had higher proportions of Gram-positive cocci (48 vs 35 %; p = 0.007) and lower proportions of Gram-negative bacilli (33 vs 44 %; p = 0.03), anaerobes (4 vs 10 %; p = 0.04), and multidrug-resistant strains (20 vs 40 %; p = 0.01). Despite higher rates of adequate empiric antibiotic therapy (82 vs 64 %; p = 0.024) and high de-escalation rates (67 % in BS cases and 51 % in cPOP cases; p = 0.06), BS patients had similar reoperation rates (53 vs 44 %; p = 0.278) and similar mortality rates (24 vs 32 %; p = 0.32) to cPOP patients. In multivariate analysis, none of the risk factors for death were related to BS. CONCLUSIONS: The severity of POP in BS patients resulted in high mortality rates, similar to the results observed in cPOP. Usual empiric antibiotic therapy protocols should be applied to target multidrug-resistant microorganisms, but de-escalation can be performed in most cases.