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August 22/29, 2007

When Not Being Superior May Not Be Good Enough

Author Affiliations

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

JAMA. 2007;298(8):924-925. doi:10.1001/jama.298.8.924

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.