Standardization of the strategy for open abdomen in nontrauma emergency laparotomy: A prospective study of outcomes in primary versus temporary abdominal closure.
Journal
Surgery
ISSN: 1532-7361
Titre abrégé: Surgery
Pays: United States
ID NLM: 0417347
Informations de publication
Date de publication:
08 Aug 2024
08 Aug 2024
Historique:
received:
13
03
2024
revised:
12
06
2024
accepted:
03
07
2024
medline:
10
8
2024
pubmed:
10
8
2024
entrez:
9
8
2024
Statut:
aheadofprint
Résumé
The indications for temporary abdominal closure in nontrauma surgery are heterogeneous and with limited data on clinical outcomes. This study aimed to report the outcomes of primary closure compared with temporary abdominal closure after nontrauma emergency laparotomy within a standardized clinical setting adapted from international guidelines. Included were all nontrauma patients undergoing emergency laparotomy between January 1, 2021, and December 31, 2022, at Copenhagen University Hospital Herlev in Denmark. All patients received treatment on the basis of standardized bundle of care trajectory for major emergency abdominal surgery. Mortality, risks of re-laparotomy, and postoperative complications were assessed using Kaplan-Meier plots and multiple logistic regression modeling. Of the 576 included patients, temporary abdominal closure was performed in 57 (10%) patients in the initial surgery. Indications for temporary abdominal closure included damage control strategy as the result of considerable hemodynamic instability in 21 (37%) patients, need for reassessment of bowel viability in 21 (37%) patients, and loss of domain in 15 (25%) patients. Fascial closure was achieved after a median period of 2 days. Sixty-seven patients (12%) underwent re-laparotomy, with temporary abdominal closure performed in 10 (15%) of the cases. Patients with temporary abdominal closure had a significantly greater risk of postoperative complications (odds ratio 2.58, 95% confidence interval 1.38-4.89, P = .003). There were no significant differences in the risks of fascial dehiscence, re-laparotomy, or 30- or 90-days mortality. Temporary abdominal closure was performed in 10% of patients undergoing nontrauma emergency laparotomy, with the primary indications being damage control strategy and need for reassessment of bowel viability. Patients undergoing temporary abdominal closure had a significantly greater risk of postoperative complications.
Sections du résumé
BACKGROUND
BACKGROUND
The indications for temporary abdominal closure in nontrauma surgery are heterogeneous and with limited data on clinical outcomes. This study aimed to report the outcomes of primary closure compared with temporary abdominal closure after nontrauma emergency laparotomy within a standardized clinical setting adapted from international guidelines.
METHODS
METHODS
Included were all nontrauma patients undergoing emergency laparotomy between January 1, 2021, and December 31, 2022, at Copenhagen University Hospital Herlev in Denmark. All patients received treatment on the basis of standardized bundle of care trajectory for major emergency abdominal surgery. Mortality, risks of re-laparotomy, and postoperative complications were assessed using Kaplan-Meier plots and multiple logistic regression modeling.
RESULTS
RESULTS
Of the 576 included patients, temporary abdominal closure was performed in 57 (10%) patients in the initial surgery. Indications for temporary abdominal closure included damage control strategy as the result of considerable hemodynamic instability in 21 (37%) patients, need for reassessment of bowel viability in 21 (37%) patients, and loss of domain in 15 (25%) patients. Fascial closure was achieved after a median period of 2 days. Sixty-seven patients (12%) underwent re-laparotomy, with temporary abdominal closure performed in 10 (15%) of the cases. Patients with temporary abdominal closure had a significantly greater risk of postoperative complications (odds ratio 2.58, 95% confidence interval 1.38-4.89, P = .003). There were no significant differences in the risks of fascial dehiscence, re-laparotomy, or 30- or 90-days mortality.
CONCLUSION
CONCLUSIONS
Temporary abdominal closure was performed in 10% of patients undergoing nontrauma emergency laparotomy, with the primary indications being damage control strategy and need for reassessment of bowel viability. Patients undergoing temporary abdominal closure had a significantly greater risk of postoperative complications.
Identifiants
pubmed: 39122595
pii: S0039-6060(24)00484-7
doi: 10.1016/j.surg.2024.07.005
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
Copyright © 2024 Elsevier Inc. All rights reserved.
Déclaration de conflit d'intérêts
Conflict of interest/Disclosures The authors have no conflicts of interest to declare.