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When Not Being Superior May Not Be Good Enough
Farhood Farjah, MD, MPH;
David R. Flum, MD, MPH
JAMA. 2007;298(8):924-925.
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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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