Predictive factors of mortality in open abdomen for abdominal sepsis: a retrospective cohort study on 113 patients

Abstract

Over the past few years, the open abdomen (OA) as a part of Damage Control Surgery (DCS) has been introduced as a surgical strategy with the intent to reduce the mortality of patients with severe abdominal sepsis. Aims of our study were to analyze the OA effects on patients with abdominal sepsis and identify predictive factors of mortality. Patients admitted to our institution with abdominal sepsis requiring OA from 2010 to 2019 were retrospectively analyzed. Primary outcomes were mortality, morbidity and definitive fascial closure (DFC). Comparison between groups was made via univariate and multivariate analyses. On 1474 patients operated for abdominal sepsis, 113 (7.6%) underwent OA. Male gender accounted for 52.2% of cases. Mean age was 68.1 ± 14.3 years. ASA score was > 2 in 87.9%. Mean BMI, APACHE II score and Mannheim Peritonitis Index were 26.4 ± 4.9, 15.3 ± 6.3, and 22.6 ± 7.3, respectively. A negative pressure wound system technique was used in 47% of the cases. Overall, mortality was 43.4%, morbidity 76.6%, and DFC rate was 97.8%. Entero-atmospheric fistula rate was 2.2%. At multivariate analysis, APACHE II score (OR 1.18; 95% CI 1.05–1.32; p = 0.005), Frailty Clinical Scale (OR 4.66; 95% CI 3.19–6.12; p < 0.0001) and ASA grade IV (OR 7.86; 95% CI 2.18–28.27; p = 0.002) were significantly associated with mortality. OA seems to be a safe and reliable treatment for critically ill patients with severe abdominal sepsis. Nonetheless, in these patients, co-morbidity and organ failure remain the major obstacles to a better prognosis.

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 ].…”

“…Specific OA treatment variables, such as OA duration, number of looks, and Björck classification, did not show significant differences between survivors and non-survivors, as in previous studies [ 8 ]. However, an issue in understanding the effect of treatment on mortality during OA is that clinical indications for OA are composite and the current prognostic scores are dominated by organ dysfunction and are insufficient to adequately select patients who can benefit from the OA technique [ 19 ].…”

“…Comorbidities were mostly represented by neoplastic, cardiovascular, metabolic, and pulmonary diseases, and were more frequent than in other series [ 6 , 17 ]. The mean BMI was high, and more than one-quarter of patients (26%, p = 0.001) presented obesity (BMI > 30 kg/m 2 ) compared to a recent study [ 8 ].…”

“…Few observational studies focused on the OA technique in septic patients [ 1 , 3 , 8 ], and a limited body of evidence is available on key outcomes of the OA technique, such as mortality and rate of fascial closure, which are needed for surgeons to adequately choose among different therapeutic strategies and select patients.…”

Prognostic significance of comorbidities in patients with diffuse peritonitis

“…This predictor may also be used in patients with peritonitis to estimate the course of the disease and shortterm prognosis. However, our study focused on identification of individual comorbidities or initial data associated with a significantly worse disease course, i.e., cases where the open abdomen method with an NPWT technique could be used to improve the patient's prognosis [12]. The use of NPWT in the therapy of diffuse secondary peritonitis is still a topical issue, and results remain dubious.…”