The Open Abdomen Route by EuraHS: introduction of the data set and initial results of procedures and procedure-related complications

Willms, Arnulf; Muysoms, Filip; Güsgen, Christoph; Schwab, Robert; Lock, Johan Friso; Schaaf, Sebastian; Germer, Christoph‐Thomas; Richardsen, I.; Dietz, Ulrich

doi:10.1007/s10029-017-1572-4

Cited by 18 publications

(12 citation statements)

References 30 publications

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“…A multi-center trial which randomizes between early decompressive surgery with open abdomen management and medical management in ACS patients might answer some of the many remaining questions. To base open abdomen management on sufficient evidence, a laparostomy registry entitled Open Abdomen Route has been implemented in 2015 [29]. An interim analysis shows that in 649 patients with open abdomen management, the indication to open the abdomen was postoperative ACS in 19 patients (2.9%) and pancreatitis in 37 patients (5.7%) [30].…”

Section: Discussionmentioning

confidence: 99%

Intra-abdominal hypertension and abdominal compartment syndrome in patients admitted to the ICU

Smit

Koopman

Dieperink

et al. 2020

Ann. Intensive Care

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Background Intra-abdominal hypertension is frequently present in critically ill patients and is an independent predictor for mortality. Risk factors for intra-abdominal hypertension and abdominal compartment syndrome have been widely investigated. However, data are lacking on prevalence and outcome in high-risk patients. Our objectives in this study were to investigate prevalence and outcome of intra-abdominal hypertension and abdominal compartment syndrome in high-risk patients in a prospective, observational, single-center cohort study. Results Between March 2014 and March 2016, we included 503 patients, 307 males (61%) and 196 females (39%). Patients admitted to the intensive care unit with a diagnosis of pancreatitis, elective or emergency open abdominal aorta surgery, orthotopic liver transplantation, other elective or emergency major abdominal surgery and trauma were enrolled. One hundred and sixty four (33%) patients developed intra-abdominal hypertension and 18 (3.6%) patients developed abdominal compartment syndrome. Highest prevalence of abdominal compartment syndrome occurred in pancreatitis (57%) followed by orthotopic liver transplantation (7%) and abdominal aorta surgery (5%). Length of intensive care stay increased by a factor 4 in patients with intra-abdominal hypertension and a factor 9 in abdominal compartment syndrome, compared to patients with normal intra-abdominal pressure. Rate of renal replacement therapy was higher in abdominal compartment syndrome (38.9%) and intra-abdominal hypertension (8.2%) compared to patients with normal intra-abdominal pressure (1.2%). Both intensive care mortality and 90-day mortality were significantly higher in intra-abdominal hypertension (4.8% and 15.2%) and abdominal compartment syndrome (16.7% and 38.9%) compared to normal intra-abdominal pressure (1.2% and 7.1%). Body mass index (odds ratio 1.08, 95% confidence interval 1.03–1.13), mechanical ventilation at admission (OR 3.52, 95% CI 2.08–5.96) and Apache IV score (OR 1.03, 95% CI 1.02–1.04) were independent risk factors for the development of intra-abdominal hypertension or abdominal compartment syndrome. Conclusions The prevalence of abdominal compartment syndrome was 3.6% and the prevalence of intra-abdominal hypertension was 33% in this cohort of high-risk patients. Morbidity and mortality increased when intra-abdominal hypertension or abdominal compartment syndrome was present. The patient most at risk of IAH or ACS in this high-risk cohort has a BMI > 30 kg/m2 and was admitted to the ICU after emergency abdominal surgery or with a diagnosis of pancreatitis.

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Section: Discussionmentioning

confidence: 99%

Intra-abdominal hypertension and abdominal compartment syndrome in patients admitted to the ICU

Smit

Koopman

Dieperink

et al. 2020

Ann. Intensive Care

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“…The primary fascial closure rates which are the focus of surgical management (as only fascial closure as a "surgical factor" significantly reduces mortality and morbidity) were also relatively low in this historic cohort (only 9/40 patients, 23%). Recent algorithms such as the utilization of a consequent three-column approach (fascial traction, visceral protection, negative pressure wound treatment) have significantly improved primary closure rates over time not only at our institution (22). In the historic cohort reported here, a primary closure was not achieved in the majority of cases, which would not be acceptable compared to contemporary standards.…”

Section: Discussionmentioning

confidence: 78%

Long Term Outcome After Open Abdomen Treatment: Function and Quality of Life

et al. 2021

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Background: Open abdomen treatment (OAT) is widely accepted to manage severe abdominal conditions such as peritonitis and abdominal compartment syndrome but can be associated with high morbidity and mortality. The main risks in OAT are (1) entero-atmospheric fistula (EAF), (2) failure of primary fascial closure, and (3) incisional hernias. In this study, we assessed the long-term functional outcome after OAT to understand which factors impacted most on quality of life (QoL)/daily living activities and the natural course after OAT.Materials and Methods: After a retrospective analysis of 165 consecutive OAT patients over a period of 10 years (2002–2012) with over 65 clinical parameters that had been performed at our center (1), we initiated a prospective structured follow-up approach. All survivors were invited for a clinical follow-up. Forty complete datasets including clinical and social follow-up with SF-36 scores were available for full analysis.Results: The patients were dominantly male (75%) with a median age of 52 years. Primary fascial closure (PC) was achieved in 9/40 (23%), while in 77% a planned ventral hernia (PVH) approach was followed. A total of 3/4 of the PVH patients underwent a secondary-stage abdominal wall reconstruction (SSR), but 2/3 of these reconstructed patients developed recurrent hernias. Fifty-five percent of the patients with PC developed an incisional hernia, while 20% of all patients developed significant scarring (Vancouver Scar Score >8). Scar pain was described by 15% of the patients as “moderate” [Visual Analog Scale (VAS) 4–6] and by 10% as “severe” (VAS > 7). While hernia presence, PC or PVH, and scarring showed no impact on QoL, male sex and especially EAF formation significantly reduced QoL.Discussion: Despite many advantages, OAT was associated with relevant mortality and morbidity, especially in the early era before the implementation of a structured concept at our center. Follow-up revealed that hernia incidence after OAT and secondary reconstruction were high and that 25% of patients qualifying for a secondary reconstruction either did not want surgery or were unfit. Sex and EAF formation impacted significantly on QoL, which was lower than in the general population. With regard to hernia incidence, new strategies such as prophylactic mesh implantation upon fascial closure should be discussed analogous to other major abdominal procedures.

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“…The current series supports a growing body of literature showing that the incidence of enterocutaneous fistula in the contaminated abdomen is not different when compared to a cohort without synthetic, intraperitoneal mesh implantation [ 8 , 9 , 17 – 19 ]. Visceral protection with dual-layered meshes seems to be a key element in prevention of mesh-related intestinal fistula in these patients [ 20 ]. Because of this additional barrier function, the VAC-IPOM technique also allows bedside subcutaneous VAC treatment, avoiding unnecessary re-operations.…”

Section: Discussionmentioning

confidence: 99%

Mesh-augmented versus direct abdominal closure in patients undergoing open abdomen treatment

Jakob

Schwarz

Haltmeier

et al. 2018

Hernia

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BackgroundOpen abdomen (OA) may be required in patients with abdominal trauma, sepsis or compartment syndrome. Vacuum-assisted wound closure and mesh-mediated fascial traction (VAWCM) is a widely used approach for temporary abdominal closure to close the abdominal wall. However, this method is associated with a high incidence of re-operations in short term and late sequelae such as incisional hernia. The current study aims to compare the results of surgical strategies of OA with versus without permanent mesh augmentation.MethodsPatients with OA treatment undergoing vacuum-assisted wound closure and an intraperitoneal onlay mesh (VAC-IPOM) implantation were compared to VAWCM with direct fascial closure which represents the current standard of care. Outcomes of patients from two tertiary referral centers that performed the different strategies for abdominal closure after OA treatment were compared in univariate and multivariate regression analysis.ResultsA total of 139 patients were included in the study. Of these, 50 (36.0%) patients underwent VAC-IPOM and 89 (64.0%) patients VAWCM. VAC-IPOM was associated with reduced re-operations (adjusted incidence risk ratio 0.48 per 10-person days; CI 95% = 0.39–0.58, p < 0.001), reduced duration of stay on intensive care unit (ICU) [adjusted hazard ratio (aHR) 0.53; CI 95% = 0.36–0.79, p = 0.002] and reduced hospital stay (aHR 0.61; CI 95% = 0.040–0.94; p = 0.024). In-hospital mortality [22.5 vs 18.0%, risk difference − 4.5; confidence interval (CI) 95% = − 18.2 to 9.3; p = 0.665] and the incidence of intestinal fistula (18.0 vs 22.0%, risk difference 4.0; CI 95% = −10.0 to 18.0; p = 0.656) did not differ between the two groups. In Kaplan–Meier analysis, hernia-free survival was significantly increased after VAC-IPOM (p = 0.041).ConclusionsIn patients undergoing OA treatment, intraperitoneal mesh augmentation is associated with a significantly decreased number of re-operations, duration of hospital and ICU stay and incidence of incisional hernias when compared to VAWCM.Electronic supplementary materialThe online version of this article (10.1007/s10029-018-1798-9) contains supplementary material, which is available to authorized users.

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The Open Abdomen Route by EuraHS: introduction of the data set and initial results of procedures and procedure-related complications

Cited by 18 publications

References 30 publications

Intra-abdominal hypertension and abdominal compartment syndrome in patients admitted to the ICU

Intra-abdominal hypertension and abdominal compartment syndrome in patients admitted to the ICU

Long Term Outcome After Open Abdomen Treatment: Function and Quality of Life

Mesh-augmented versus direct abdominal closure in patients undergoing open abdomen treatment

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