Predictive factors of mortality in open abdomen for abdominal sepsis: a retrospective cohort study on 113 patients.
Abdominal sepsis
Damage control
Morbidity
Mortality
Negative pressure
Open abdomen
Journal
Updates in surgery
ISSN: 2038-3312
Titre abrégé: Updates Surg
Pays: Italy
ID NLM: 101539818
Informations de publication
Date de publication:
Oct 2021
Oct 2021
Historique:
received:
26
10
2020
accepted:
22
02
2021
pubmed:
9
3
2021
medline:
16
10
2021
entrez:
8
3
2021
Statut:
ppublish
Résumé
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.
Identifiants
pubmed: 33683639
doi: 10.1007/s13304-021-01012-8
pii: 10.1007/s13304-021-01012-8
pmc: PMC8500907
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1975-1982Informations de copyright
© 2021. The Author(s).
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