Open abdomen: is a dedicated emergency surgery team needed? A single center retrospective study on 141 consecutive patients.
acute care surgery
emergency general surgery
open abdomen
septic abdomen
Journal
ANZ journal of surgery
ISSN: 1445-2197
Titre abrégé: ANZ J Surg
Pays: Australia
ID NLM: 101086634
Informations de publication
Date de publication:
09 2022
09 2022
Historique:
revised:
08
06
2022
received:
05
04
2022
accepted:
14
07
2022
pubmed:
31
7
2022
medline:
15
9
2022
entrez:
30
7
2022
Statut:
ppublish
Résumé
Open Abdomen (OA) is widely used when facing a catastrophic abdomen. Still, no indication is validated by a strong and high quality of evidence. The study reports the 5 year experience of a dedicated emergency general surgery (EGS) team. Retrospective observational cohort study. Patients undergoing OA management from 2/01/2015 to 19/07/2020 for trauma, non-traumatic emergencies or rescue surgery. One hundred and forty-one patients. Age 66.9 ± 15.1. Male 58.2%.9.3% OA for trauma, 64.5% for non-traumatic emergencies and 26.2% for rescue surgery. 40.4% performed by the EGS team 52.4% indication for surgery was a severe intra-abdominal infection. TAC device: commercial negative pressure wound therapy (NPWT) (83%), Sandwich VAC (12%), commercial NPWT with polypropylene mesh (5%) for pregressive fascial traction. Enteroatmospheric fistula (EAF) in 3 patients. OA duration 5.3 days (1-25). A 1.8 revision surgeries (0-12) required for definitive closure; ICU stay 9.9 days (0-78). 30-day mortality 23.5%. Overall and 1-year mortality were 47.5% and 43.3%. Overall survival 9.9 months. An increased one-year mortality rate was found in the >65 group (P = 0.01). We reported a wide use of OA in septic abdomen (90% of cases). We had a low rate of EAF, short ICU stay and OA duration. These results are related to the fact that patients were treated by a dedicated EGS team, suggesting that OA management should be cared for as much as possible by trained and experienced surgeons. Prospective studies with more accurate patient selection are needed to prove our conclusions.
Sections du résumé
BACKGROUND
Open Abdomen (OA) is widely used when facing a catastrophic abdomen. Still, no indication is validated by a strong and high quality of evidence. The study reports the 5 year experience of a dedicated emergency general surgery (EGS) team.
METHODS
Retrospective observational cohort study. Patients undergoing OA management from 2/01/2015 to 19/07/2020 for trauma, non-traumatic emergencies or rescue surgery.
RESULTS
One hundred and forty-one patients. Age 66.9 ± 15.1. Male 58.2%.9.3% OA for trauma, 64.5% for non-traumatic emergencies and 26.2% for rescue surgery. 40.4% performed by the EGS team 52.4% indication for surgery was a severe intra-abdominal infection. TAC device: commercial negative pressure wound therapy (NPWT) (83%), Sandwich VAC (12%), commercial NPWT with polypropylene mesh (5%) for pregressive fascial traction. Enteroatmospheric fistula (EAF) in 3 patients. OA duration 5.3 days (1-25). A 1.8 revision surgeries (0-12) required for definitive closure; ICU stay 9.9 days (0-78). 30-day mortality 23.5%. Overall and 1-year mortality were 47.5% and 43.3%. Overall survival 9.9 months. An increased one-year mortality rate was found in the >65 group (P = 0.01).
CONCLUSIONS
We reported a wide use of OA in septic abdomen (90% of cases). We had a low rate of EAF, short ICU stay and OA duration. These results are related to the fact that patients were treated by a dedicated EGS team, suggesting that OA management should be cared for as much as possible by trained and experienced surgeons. Prospective studies with more accurate patient selection are needed to prove our conclusions.
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
2213-2217Informations de copyright
© 2022 Royal Australasian College of Surgeons.
Références
Coccolini F, Roberts D, Ansaloni L et al. The open abdomen in trauma and non-trauma patients: WSES guidelines. World J. Emerg. Surg. 2018; 13: 7. https://doi.org/10.1186/s13017-018-0167-4.
Cheatham ML, Safcsak K. Is the evolving management of intra-abdominal hypertension and abdominal compartment syndrome improving survival? Crit. Care Med. 2010; 38: 402-7. https://doi.org/10.1097/ccm.0b013e3181b9e9b1.
Finlay IG, Edwards TJ, Lambert AW. Damage control laparotomy. Br. J. Surg. 2004; 91: 83-5. https://doi.org/10.1002/bjs.4434.
Beckman M, Paul J, Neideen T, Weigelt JA. Role of the open abdomen in critically ill patients. Crit. Care Clin. 2016; 32: 255-64. https://doi.org/10.1016/j.ccc.2015.12.003.
Chabot E, Nirula R. Open abdomen critical care management principles: resuscitation, fluid balance, nutrition, and ventilator management. Trauma Surg. Acute Care Open. 2017; 2: e000063. https://doi.org/10.1136/tsaco-2016-000063.
Boffard KD. Manual of Definitive Surgical Trauma Care, 2019. [Cited 7 May 2021.] Available from URL: https://search.ebscohost.com/login.aspx?direct=true&scope=site&db=nlebk&db=nlabk&AN=2143061
Ribeiro MAF, Costa CTK, De Souza Augusto S et al. The role of direct peritoneal resuscitation in the treatment of hemorrhagic shock after trauma and in emergency acute care surgery: a systematic review. Eur. J. Trauma Emerg. Surg. Off. Publ. Eur. Trauma Soc. 2021; 13: 791-7. https://doi.org/10.1007/s00068-021-01821-x.
Kirkpatrick AW. Closed versus open abdomen in the surgical treatment of severe secondary peritonitis: A randomized controlled clinical trial. clinicaltrials.gov; 2020. [Cited 22 August 2021.] Available from URL: https://clinicaltrials.gov/ct2/show/NCT03163095
Smith JW, Neal Garrison R, Matheson PJ et al. Adjunctive treatment of abdominal catastrophes and sepsis with direct peritoneal resuscitation: indications for use in acute care surgery. J. Trauma Acute Care Surg. 2014; 77: 393-8. https://doi.org/10.1097/TA.0000000000000393.
Crafts TD, Hunsberger EB, Jensen AR, Rescorla FJ, Yoder MC, Markel TA. Direct peritoneal resuscitation improves survival and decreases inflammation after intestinal ischemia and reperfusion injury. J. Surg. Res. 2015; 199: 428-34. https://doi.org/10.1016/j.jss.2015.06.031.
Demetriades D, Salim A. Management of the open abdomen. Surg. Clin. North Am. 2014; 94: 131-53. https://doi.org/10.1016/j.suc.2013.10.010.
Coccolini F, Ceresoli M, Kluger Y et al. Open abdomen and entero-atmospheric fistulae: an interim analysis from the international register of open abdomen (IROA). Injury 2019; 50: 160-6. https://doi.org/10.1016/j.injury.2018.09.040.
Chen Y, Ye J, Song W, Chen J, Yuan Y, Ren J. Comparison of outcomes between early fascial closure and delayed abdominal closure in patients with open abdomen: a systematic review and meta-analysis. Gastroenterol. Res. Pract. 2014; 2014: 784056. https://doi.org/10.1155/2014/784056.
Coccolini F, Perrina D, Ceresoli M et al. Open abdomen and age; results from IROA (international register of open abdomen). Am. J. Surg. 2020; 220: 229-36. https://doi.org/10.1016/j.amjsurg.2019.11.022.
Morais M, Gonçalves D, Bessa-Melo R, Devesa V, Costa-Maia J. The open abdomen: analysis of risk factors for mortality and delayed fascial closure in 101 patients. Porto Biomed. J. 2018; 3: e14. https://doi.org/10.1016/j.pbj.0000000000000014.
Miller RS, Morris JA, Diaz JJ, Herring MB, May AK. Complications after 344 damage-control open celiotomies. J. Trauma. 2005; 59: 1365-71. https://doi.org/10.1097/01.ta.0000196004.49422.af.
Patel NY, Cogbill TH, Kallies KJ, Mathiason MA. Temporary abdominal closure: long-term outcomes. J. Trauma 2011; 70: 769-74. https://doi.org/10.1097/TA.0b013e318212785e.
Regner JL, Kobayashi L, Coimbra R. Surgical strategies for management of the open abdomen. World J. Surg. 2012; 36: 497-510. https://doi.org/10.1007/s00268-011-1203-7.