Delayed fascial closure in nontrauma abdominal emergencies: A nationwide analysis.

Abdominal Injuries / surgery Abdominal Wound Closure Techniques Aged Emergencies Fascia Fasciotomy Female Humans Laparotomy / adverse effects Male Retrospective Studies

Journal

Surgery
ISSN: 1532-7361
Titre abrégé: Surgery
Pays: United States
ID NLM: 0417347

Informations de publication

Date de publication:
11 2022
Historique:
received: 06 03 2022
revised: 13 06 2022
accepted: 16 06 2022
pubmed: 16 8 2022
medline: 12 10 2022
entrez: 15 8 2022
Statut: ppublish

Résumé

Initially used in trauma management, delayed abdominal closure endeavors to decrease operative time during the index operation while still being lifesaving. Its use in emergency general surgery is increasing, but the data evaluating its outcome are sparse. We aimed to study the association between delayed abdominal closure, mortality, morbidity, and length of stay in an emergency surgery cohort. The 2013 to 2017 American College of Surgeons National Surgical Quality Improvement Program database was examined for patients undergoing emergency laparotomy. The patients were classified by the timing of abdominal wall closure: delayed fascial closure versus immediate fascial closure. Propensity score matching was performed based on preoperative covariates, wound classification, and performance of bowel resection. The outcomes were then compared by univariable analysis. After matching, both the delayed fascial closure and immediate fascial closure groups consisted of 3,354 patients each. Median age was 65 years, and 52.6% were female. The delayed fascial closure group had a higher in-hospital mortality (35.3% vs 25.0%, P < .001), a higher 30-day mortality (38.6% vs 29.0%, P < .001), a higher proportion of acute kidney injury (9.5% vs 6.6%, P < .001), a lower proportion of postoperative sepsis (11.8% vs 15.6%, P < .001), and a lower proportion of surgical site infection (3.4% vs 7.0%, P < .001). Compared with immediate fascial closure, delayed fascial closure is associated with an increased mortality in the patients matched based on comorbidities and surgical site contamination. In emergency general surgery, delaying abdominal closure may not have the presumed overarching benefits, and its indications must be further defined in this population.

Sections du résumé

BACKGROUND
Initially used in trauma management, delayed abdominal closure endeavors to decrease operative time during the index operation while still being lifesaving. Its use in emergency general surgery is increasing, but the data evaluating its outcome are sparse. We aimed to study the association between delayed abdominal closure, mortality, morbidity, and length of stay in an emergency surgery cohort.
METHODS
The 2013 to 2017 American College of Surgeons National Surgical Quality Improvement Program database was examined for patients undergoing emergency laparotomy. The patients were classified by the timing of abdominal wall closure: delayed fascial closure versus immediate fascial closure. Propensity score matching was performed based on preoperative covariates, wound classification, and performance of bowel resection. The outcomes were then compared by univariable analysis.
RESULTS
After matching, both the delayed fascial closure and immediate fascial closure groups consisted of 3,354 patients each. Median age was 65 years, and 52.6% were female. The delayed fascial closure group had a higher in-hospital mortality (35.3% vs 25.0%, P < .001), a higher 30-day mortality (38.6% vs 29.0%, P < .001), a higher proportion of acute kidney injury (9.5% vs 6.6%, P < .001), a lower proportion of postoperative sepsis (11.8% vs 15.6%, P < .001), and a lower proportion of surgical site infection (3.4% vs 7.0%, P < .001).
CONCLUSION
Compared with immediate fascial closure, delayed fascial closure is associated with an increased mortality in the patients matched based on comorbidities and surgical site contamination. In emergency general surgery, delaying abdominal closure may not have the presumed overarching benefits, and its indications must be further defined in this population.

Identifiants

DOI: 10.1016/j.surg.2022.06.025 PMID: 35970609
pubmed: 35970609
pii: S0039-6060(22)00491-3
doi: 10.1016/j.surg.2022.06.025
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

1569-1575

Informations de copyright

Copyright © 2022 Elsevier Inc. All rights reserved.

Auteurs

Jefferson A Proaño-Zamudio (JA)

Division of Trauma, Emergency Surgery and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, MA. Electronic address: https://twitter.com/eljefe_md.

Anthony Gebran (A)

Division of Trauma, Emergency Surgery and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, MA. Electronic address: https://twitter.com/AnthonyGebran.

Dias Argandykov (D)

Division of Trauma, Emergency Surgery and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, MA. Electronic address: https://twitter.com/argandykov.

Ander Dorken-Gallastegi (A)

Division of Trauma, Emergency Surgery and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, MA. Electronic address: https://twitter.com/AnderDorken.

Noelle N Saillant (NN)

Division of Trauma, Emergency Surgery and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, MA. Electronic address: https://twitter.com/MGHSurgery.

Jason A Fawley (JA)

Division of Trauma, Emergency Surgery and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, MA. Electronic address: https://twitter.com/fawley85.

Louisa Onyewadume (L)

Division of Trauma, Emergency Surgery and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, MA. Electronic address: https://twitter.com/TraumaMGH.

Haytham M A Kaafarani (HMA)

Division of Trauma, Emergency Surgery and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, MA. Electronic address: https://twitter.com/hayfaarani.

Peter J Fagenholz (PJ)

Division of Trauma, Emergency Surgery and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, MA.

David R King (DR)

Division of Trauma, Emergency Surgery and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, MA.

George C Velmahos (GC)

Division of Trauma, Emergency Surgery and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, MA.

John O Hwabejire (JO)

Division of Trauma, Emergency Surgery and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, MA. Electronic address: http://jhwabejire@partners.org.

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Classifications MeSH

questionsmedicales.fr › Plaies et blessures › Traumatismes de l'abdomen › Delayed fascial closure in nontrauma abdominal...
questionsmedicales.fr › Procédures de chirurgie opératoire › Techniques de fermeture des plaies › Techniques de fermeture de plaie abdominale › Delayed fascial closure in nontrauma abdominal...
questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Sujet âgé › Delayed fascial closure in nontrauma abdominal...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Urgences › Delayed fascial closure in nontrauma abdominal...
questionsmedicales.fr › Tissus › Tissu conjonctif › Fascia › Delayed fascial closure in nontrauma abdominal...
questionsmedicales.fr › Procédures de chirurgie opératoire › Fasciotomie › Delayed fascial closure in nontrauma abdominal...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Delayed fascial closure in nontrauma abdominal...
questionsmedicales.fr › Procédures de chirurgie opératoire › Laparotomie › Delayed fascial closure in nontrauma abdominal...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Études rétrospectives › Delayed fascial closure in nontrauma abdominal...