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Farhood Farjah, MD, MPH; David R. Flum, MD, MPH

JAMA. 2007;298(8):924-925.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

In this issue of JAMA, van Ruler and colleagues¹ report the results of a multicenter randomized trial comparing 2 strategies of operative management for patients with severe peritonitis. Although the study did not reveal a statistically significant benefit of an on-demand relaparotomy strategy over a planned relaparotomy approach in terms of death or major morbidity, there were fewer relaparotomies, shorter hospital and intensive care unit stays, and lower costs favoring the on-demand approach. The authors suggest that the on-demand approach may be the preferred strategy for patients with severe peritonitis.

The design of this trial was informed by prior work suggesting better outcomes associated with an on-demand strategy.^2-5 Accordingly, the authors hypothesized that the proportion of adverse events among the on-demand group would be 16% lower than among the planned relaparotomy group. This superiority hypothesis (that on-demand is a better . . . [Full Text of this Article]

Author Affiliations: Department of Surgery, University of Washington, Seattle. Dr Flum is Contributing Editor, JAMA.

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