Spill Your Guts! Perceptions of Trauma Association of Canada Member Surgeons Regarding the Open Abdomen and the Abdominal Compartment Syndrome

• Published in: The Journal of trauma, injury, infection, and critical care Vol. 60; no. 2; pp. 279 - 286
• Main Authors: Kirkpatrick, Andrew W., Laupland, Kevin B., Karmali, Shahzeer, Bergeron, Eric, Stewart, T Charyk, Findlay, Christie, Parry, N, Khetarpal, Suneel, Evans, D
• Format: Journal Article Conference Proceeding
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins, Inc 01-02-2006; Lippincott Williams & Wilkins
• Subjects: Abdomen - surgery; Attitude of Health Personnel; Biological and medical sciences; Blood and lymphatic vessels; Canada; Cardiology. Vascular system; Clinical Competence - standards; Compartment Syndromes - diagnosis; Compartment Syndromes - etiology; Compartment Syndromes - prevention & control; Decision Making; Diseases of the osteoarticular system; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Fasciotomy; Forecasting; Health Services Needs and Demand; Humans; Injuries of the limb. Injuries of the spine; Laparotomy - adverse effects; Laparotomy - education; Laparotomy - methods; Laparotomy - statistics & numerical data; Mass Screening; Medical sciences; Patient Selection; Physical Examination; Physicians - organization & administration; Physicians - psychology; Practice Guidelines as Topic; Practice Patterns, Physicians' - statistics & numerical data; Recurrence; Reoperation; Self Efficacy; Societies, Medical; Surgical Mesh; Surveys and Questionnaires; Suture Techniques; Time Factors; Traumas. Diseases due to physical agents; Traumatology - education; Traumatology - methods; Traumatology - statistics & numerical data; Canada; North America; America; Pediatrics; Abdominal compartment syndrome; Questionnaire; Closure; Surgical therapy; Critical care; Cardiovascular disease; Arterial disease; Vascular disease; Direct current; Blood vessel; Child; Compartment syndrome; Public health; Resuscitation; Human; Gut; Definition; Trauma; Surgeon; Care; Abdomen; Intra-abdominal hypertension; Symptomatology; Striated muscle disease; Survey; Treatment; Perception; Fascia; Laparotomy
• ISSN: 0022-5282; 1529-8809
• DOI: 10.1097/01.ta.0000205638.26798.dc

BACKGROUND:To survey surgeon opinion regarding the management of the open abdomen (OA) and abdominal compartment syndrome (ACS) to assess current practice and direct future prospective clinical studies.
METHODS:Opinions of self-designated trauma, general, pediatric, and vascular surgeons belonging to the Trauma Association of Canada (TAC), were surveyed through a mixed-mode (mail and Web based) questionnaire.
RESULTS:Among 102 eligible candidates, 86 (84%) responded; 83% did regular trauma call, 45% regular critical care call being a separate call 79% of the time; 79% worked in centers serving >500,000 people; the median year of practice entry was 1997. There was no standard definition of what constituted an “open abdomen”, preferred time for re-operation, or preferred method for alternate fascial closure, although 90% reported having not closing the fascia after a trauma laparotomy. Being “physically unable” was reported as an indication twice as often as objective measures of airway or bladder pressures. The decision to proceed with OA was reported as rarely or never being made preoperatively by 78% of respondents. None reported an institutional policy regarding OA. Eighty-four percent reported (re)opening an abdomen for primary ACS, 46% for secondary ACS, 28% for tertiary ACS. Self-assessed familiarity for the ACS was 6/7 on a Likert scale. Physical examination was reported as a diagnostic criterion for ACS by 66%, and used to screen by 21% of respondents.
CONCLUSIONS:There is no consensus regarding definition, functional indications, or management of an open abdomen in the perceptions of Canadian trauma providers despite a high self reported level of familiarity with the abdominal compartment syndrome. This is an area of practice with potential and requirements for further multi-center study.