Open Abdomen in Obese Patients: Pay Attention! New Evidences from IROA, the International Register of Open Abdomen

Abstract

Background Open abdomen is the cornerstone of damage control strategies in acute care and trauma surgery. The role of BMI has not been well investigated. The aim of the study was to assess the role of BMI in determining outcomes after open abdomen. Methods This is an analysis of patients recorded into the International Register of Open Abdomen; patients were classified in two groups according to BMI using a cutoff of 30 kg/m 2 . The primary outcome was in-hospital mortality; secondary outcomes were primary fascia closure rate, length of treatment, complication rate, enteroatmospheric fistula rate and length of ICU stay. Results A total of 591 patients were enrolled from 57 centers, and obese patients were 127 (21.5%). There was no difference in mortality between the two groups; complications developed during the open treatment were higher in obese patients (63.8% vs. 53.4%, p = 0.038) while post-closure complications rate was similar. Obese patients had a significantly longer duration of the open treatment (9.1 ± 11.5 days vs. 6.3 ± 7.5 days; p = 0,002) and lower primary fascia closure rate (75.5% vs. 89.5%; p \ 0,001). No differences in fistula rate were found. There was a linear correlation between the duration of open abdomen and the BMI (Pearson's linear correlation coefficient = 0,201; p \ 0,001). Conclusions Open abdomen in obese patients seems to be safe as in non-obese patients with similar mortality; however, in obese patients the length of open abdomen is significantly higher with higher complication rate, longer ICU length of stay and lower primary fascia closure rate. Trial registration number ClinicalTrials.gov, Identifier: NCT02382770.

Patients with an Open Abdomen in Asian, American and European Continents: A Comparative Analysis from the International Register of Open Abdomen (IROA)

“…In this study the median BMI of Asiatic patients was 26 and 68 (61.8%) were obese. The association between obesity and adverse associated to OA as higher morbidity and mortality, longer ICU and hospital stay may partially explain the different overall outcomes found in the different continents [ 5 ]. Moreover, the prevalence of ASA score ≥ 3 in Europe and Asia suggests that amore unfavorable characteristics of these patients respect American ones with, consequently, greater probability of develop complications related to OA.…”

“…Several centers from American, European and Asiatic continent contributed to the register. A number of publications, derived from IROA, investigated the different aspects of the OA management [4][5][6][7]. Therefore, in 2018 the WSES provided the international guidelines with the purpose to standardize the management of the OA as much as possible [8].…”

Retrospective Study of Indications and Outcomes of Open Abdomen with Negative Pressure Wound Therapy Technique for Abdominal Sepsis in a Tertiary Referral Centre

“…The mean duration of both the OA and the ICU stay were greater than in a recent, larger study [ 8 ], despite the mean MPI and APACHE II scores being similar. The longer OA treatments and ICU stays might be attributable to the higher proportion of obese patients treated in this study, as recent evidence from the International Register of Open Abdomen (IROA) supports [ 23 ].…”

Modified Application of the Abdominal Re-Approximation Anchor Device in the Closure of Septic Open Abdomen in a Patient With Class III Obesity

“…However, these methods may cause damage to the fascial edges and often fail to address the issue of fascial retraction, complicating successful closure [ 8 , 9 ]. For complex OA patients with obesity, primary fascial closure via these techniques is associated with higher rates of re-operation due to poor skin closure and surgical site infection [ 6 , 10 , 11 ].…”