Intra-abdominal hypertension and abdominal compartment syndrome in patients undergoing gastrointestinal surgery

Abstract

Background. Intra-abdominal hypertension (IAH) and the abdominal compartment syndrome (ACS) are associated with high morbidity and mortality rates in surgical patients. Most studies on IAH and ACS have been conducted on patients on the intensive care unit (ICU) and have included both medical and surgical patients. We studied the incidence of Intra-Abdominal Hypertension and Abdominal Compartment Syndrome in patients who have undergone abdominal surgery exclusively, the factors associated with their occurrence and their final outcome. Aim. To evaluate the incidence of Intra-Abdominal Hypertension and Abdominal Compartment Syndrome, the associated factors and their outcome in patients who have undergone gastrointestinal surgery. Methods. Between September 2012 and November 2013, we prospectively recorded the IAH through the intravesical route in 895 consecutive patients who had undergone surgery in our department of Gastrointestinal Surgery at Sir Ganga Ram Hospital, New Delhi, India. We excluded those who are under 18 years old. Results. Out of the 895 patients included in the study, 137 (15.3%) and 29 (3.2%) patients were diagnosed with IAH and ACS, respectively. IAH and ACS were most commonly associated with acute necrotizing pancreatitis (ANP), being significantly more common in ICU patients compared to those in the ward (40.2% vs 5.5%). The most common complication was bleeding and low hemoglobin levels that required blood products or inotropes (15.6%) followed by septicemia (15.5%). Most (70%) of the patients had grade I or II IAH. Mortality was significantly higher in patients operated on as emergencies and groups having IAH and ACS than those without IAH (29.9% and 57.1% vs 4.1% respectively). Keywords  intra-abdominal hypertension (IAH), abdominal compartment syndrome (ACS), intensive care unit (ICU) Highlights ✓ Young males, patients on the ICU who were on ventilators and inotropic support, and patients undergoing emergency operations especially for acute necrotizing pancreatitis are at a higher risk of developing intra-abdominal hypertension and abdominal compartment syndrome compared to the ward patients.