Nontrauma open abdomens: A prospective observational study

• Published in: The journal of trauma and acute care surgery Vol. 80; no. 4; pp. 631 - 636
• Main Authors: Bruns, Brandon R, Ahmad, Sarwat A, OʼMeara, Lindsay, Tesoriero, Ronald, Lauerman, Margaret, Klyushnenkova, Elena, Kozar, Rosemary, Scalea, Thomas M, Diaz, Jose J
• Format: Journal Article
• Language: English
• Published: United States 01-04-2016
• Subjects: Abdominal Injuries - mortality; Abdominal Injuries - surgery; Aged; Comorbidity; Emergencies; Female; Hospital Mortality; Humans; Laparotomy; Length of Stay - statistics & numerical data; Male; Middle Aged; Prospective Studies; Survival Rate; Treatment Outcome
• ISSN: 2163-0755; 2163-0763
• DOI: 10.1097/TA.0000000000000958

Damage-control surgery with open abdomen (OA) is described for trauma, but little exists regarding use in the emergency general surgery. This study aimed to better define the following: demographics, indications for surgery and OA, fascial and surgical site complications, and in-hospital/long-term mortality. We hypothesize that older patients will have increased mortality, patients will have protracted stays, they will require specialized postdischarge care, and the indications for OA will be varied.
A prospective observational study of emergency general surgery OA patients from June 2013 to June 2014 was performed. Demographics, clinical/operative variables, comorbidities, indications for procedure and OA, wound/fascial complications, and disposition were collected. Patients were stratified into age groups (≤ 60, 61-79, and ≥ 80 years). Six-month and 1-year mortality was determined by query of the Social Security Death Index.
A total of 338 laparotomies were performed, of which 96 (28%) were managed with an OA. Median age was 61 years (interquartile range [IQR], 0-68 years), and 51% were male. The median Charlson Comorbidity Index was 2 (IQR, 1.5-5.1), and the median hospital stay was 25 days (IQR, 15-50 days). The most common indications for operation were perforated viscus/free air (20%), mesenteric ischemia (17%), peritonitis (16%), and gastrointestinal hemorrhage (12%). The most common indication for OA was damage control (37%). In the 63 patients with fascial closure, there were 9 (14%) wound infections and 6 (10%) fascial dehiscences. A total of 30% of the patients died in the hospital, and an additional six patients died 6 months after discharge. Patients in the oldest age stratum were more likely to die at 6 months than those in the lower strata.
Older patients were more likely to die by 6 months, the median hospital stay was 3 weeks, and there were multiple indications for OA management. With a 6-month mortality of 36% and 70% of survivors requiring postdischarge care, this population represents a critically ill population meriting additional study.
Prognostic and epidemiologic study, level III.