The open abdomen: analysis of risk factors for mortality and delayed fascial closure in 101 patients

Abstract

Introduction: The core concepts of damage control and open abdomen in trauma surgery have been expanding for emergent general surgery. Temporary closures allow ease of access to the abdominal cavity for source control. The aim of the current study was to assess the outcomes of patients who underwent open abdomen management for acute abdominal conditions and evaluate risk factors for worse outcomes and inability of fascial closure during the initial hospitalization. Methods: We conducted a retrospective analysis of 101 patients submitted to laparostomy in a single institution from January 2009 to March 2017. The evaluated outcomes were mortality, local morbidity, and rate of primary fascial closure. Results: The most common indications for open abdomen were bowel perforation, bowel ischemia, and necrotizing pancreatitis. Global in-hospital mortality rate was 62.4%. For the 37 patients discharged from the hospital, a definitive abdominal closure was attained in 28. Multivariable logistic regression analysis revealed that people older than 60 years of age and with Acute Physiology and Chronic Health Evaluation (APACHE II) scores over 18.5 had higher in-hospital mortality rates. Definitive fascial closure was statistically associated with a lower number of re-interventions and ICU stay. Conclusions: Open abdomen management may be appropriate in these critically ill patients; however, it continues to be associated with significantly high mortality, especially in elder patients and with higher APACHE II scores. Recognition of risk factors for fascia closure failure should promote the investigation for a tailored surgical approach in these patients.

Open abdomen: is a dedicated emergency surgery team needed? A single center retrospective study on 141 consecutive patients

“…13 In our experience, definitive fascial closure was achieved in 5.1 days on average . This result is consistent with the current literature, [14][15][16][17] and it falls below the 7-9 days within which it is recommended to definitively closure in order to avoid the occurrence of local complications (e.g., EAF) and late complications as ventral hernias. 11,12,16,18 With our study we underline the importance of having a well-trained team of surgeons caring for these very complex patients in order to minimize the time of OA.…”

“…14 Morais et al found a statistically significant correlation between mortality, age (greater than 60 years), and APACHE II score, whereas Bjorck classification and SOFA score did not demonstrate any significant association with mortality. 15 In our study we validate the association between age and mortality after one year from the first OA managements with a p-value equal to 0.01. Further studies in our institution are ongoing to better correlate age, comorbidities and frailty with mortality.…”

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

“…Furthermore, they found that greater number of reinterventions and longer ICU stay were associated with inability to primarily close the fascia. As a consequence, the authors concluded that the recognition of these risk factors should be promoted to guarantee a tailored surgical approach in these patients [ 22 ]. In addition, Tolonen et al identified as significantly factors associated to mortality, advanced age, higher Charlson Comorbidity Index, preoperative organ dysfunctions, higher MPI, prophylactic indication for OA, and higher SOFA scores in the ICU.…”

A Useful Maneuver to Install Pneumoperitoneum for Laparoscopy in a Frozen Abdomen: Case Report

“…Peritoneal adhesions prevalence after open abdominal surgery is reported in 63-97%, and one third of these patients are readmitted within the next 10 years for several conditions related to Small Bowel Obstruction (3). Abdominal Small Bowel Obstruction is the most common complication of peritoneal adhesions, being the overall prevalence close to 4.6-9%, depending on the type of procedures and the patient's postoperative evolution (6)(7)(8).…”