AVAS Best Clinical Resident Award (Tied): Management and outcomes of the open abdomen in nontrauma patients

Courtney Balentine, Anuradha Subramanian, Carlos H. Palacio, Shubhada Sansgiry, David H. Berger, Samir S. Awad

Research output: Contribution to journalArticle

11 Scopus citations

Abstract

Background: Little is known regarding the morbidity and mortality of the open abdomen technique in older nontrauma patients. Methods: A retrospective chart review identified cases of emergency laparotomy in which open abdomens were used. Results: Eighty-eight patients with open Acute Physiology and Chronic Health Evaluation (APACHE) abdomens were identified. An overall mortality rate of 34%, consistent with mortality predicted by APACHE IV score, was seen. Common complications included ventilator-associated pneumonia (30%) and acute renal failure (22%). A perioperative APACHE IV score of greater than 65 and an albumin level less than 2.5 g/dL were found to predict an increased likelihood of long-term assisted care placement after discharge from the acute care setting. Conclusions: The use of the open abdomen technique in older nontrauma patients carries acceptable morbidity and mortality given the acuity of disease. Focus on ventilator-associated pneumonia prevention and aggressive fluid resuscitation to avoid acute renal failure may improve outcomes. Need for long-term assisted care placement can be predicted early after admission based on the APACHE IV score or albumin level.

Original languageEnglish (US)
Pages (from-to)588-592
Number of pages5
JournalAmerican journal of surgery
Volume198
Issue number5
DOIs
StatePublished - Nov 1 2009
Externally publishedYes

Keywords

  • Emergency general surgery
  • Intra-abdominal catastrophe
  • Open abdomen

ASJC Scopus subject areas

  • Surgery

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