Independent predictors of enteric fistula and abdominal sepsis after damage control laparotomy: Results from the prospective AAST open abdomen registry

Matthew J. Bradley, Joseph J. DuBose, Thomas M. Scalea, John B. Holcomb, Binod Shrestha, Obi Okoye, Kenji Inaba, Tiffany K. Bee, Timothy C. Fabian, James F. Whelan, Rao R. Ivatury, Agathoklis Konstantinidis, Jay Menaker, Stephanie R. Goldberg, Martin D. Zielinski, Donald Jenkins, Stephen Rowe, Darrell Alley, John Berne, Ladonna AllenPaola G. Pieri, Starre Haney, Jeffrey A. Claridge, Katherine Kelly, Raul Coimbra, Jay Doucet, Ben Coopwood, David Keith, Carlos Brown, James M. Haan, Jeanette Ward, Stuart M. Leon, Evert Erriksson, Debbie Couillard, Marc A. De Moya, Gwendolyn M. Van Der Wilden

Research output: Contribution to journalArticle

59 Citations (Scopus)

Abstract

IMPORTANCE Enterocutaneous fistula (ECF), enteroatmospheric fistula (EAF), and intra-abdominal sepsis/abscess (IAS) are major challenges for surgeons caring for patients undergoing damage control laparotomy after trauma. OBJECTIVE To determine independent predictors of ECF, EAF, or IAS in patients undergoing damage control laparotomy after trauma, using the AAST Open Abdomen Registry. DESIGN The AAST Open Abdomen registry of patients with an open abdomen following damage control laparotomy was used to identify patients who developed ECF, EAF, or IAS and to compare these patients with those without these complications. Univariate analyses were performed to compare these groups of patients. Variables from univariate analyses differing at P < .20 were entered into a stepwise logistic regression model to identify independent risk factors for ECF, EAF, or IAS. SETTING Fourteen level I trauma centers. PARTICIPANTS A total of 517 patients with an open abdomen following damage control laparotomy. MAIN OUTCOMES AND MEASURES Complication of ECF, EAF, or IAS. RESULTS More patients in the ECF/EAF/IAS group than in the group without these complications underwent bowel resection (63 of 111 patients [57%] vs 133 of 406 patients [33%]; P < .001). Within the first 48 hours after surgery, the ECF/EAF/IAS group received more colloids (P < .03) and total fluids (P < .03) than did the group without these complications. The ECF/EAF/IAS group underwent almost twice as many abdominal reexplorations as did the group without these complications (mean [SD] number, 4.1 [4.1] vs 2.2 [3.4]; P < .001). After multivariate analysis, the independent predictors of ECF/EAF/IAS were a large bowel resection (adjusted odds ratio [AOR], 3.56 [95%CI, 1.88-6.76]; P < .001), a total fluid intake at 48 hours of between 5 and 10 L (AOR, 2.11 [95%CI, 1.15-3.88]; P = .02)or more than 10 L (AOR, 1.93 [95%CI, 1.04-3.57]; P = .04), and an increasing number of reexplorations (AOR, 1.14 [95%CI, 1.06-1.21]; P < .001). CONCLUSIONS AND RELEVANCE Large bowel resection, large-volume fluid resuscitation, and an increasing number of abdominal reexplorations were statistically significant predictors of ECF, EAF, or IAS in patients with an open abdomen after damage control laparotomy.

Original languageEnglish (US)
Pages (from-to)947-954
Number of pages8
JournalJAMA Surgery
Volume148
Issue number10
DOIs
StatePublished - Oct 2013

Fingerprint

Abdominal Abscess
Intestinal Fistula
Abdomen
Laparotomy
Fistula
Registries
Sepsis
Odds Ratio
Logistic Models
Trauma Centers
Wounds and Injuries
Colloids
Resuscitation
Multivariate Analysis

ASJC Scopus subject areas

  • Surgery

Cite this

Bradley, M. J., DuBose, J. J., Scalea, T. M., Holcomb, J. B., Shrestha, B., Okoye, O., ... Van Der Wilden, G. M. (2013). Independent predictors of enteric fistula and abdominal sepsis after damage control laparotomy: Results from the prospective AAST open abdomen registry. JAMA Surgery, 148(10), 947-954. https://doi.org/10.1001/jamasurg.2013.2514

Independent predictors of enteric fistula and abdominal sepsis after damage control laparotomy : Results from the prospective AAST open abdomen registry. / Bradley, Matthew J.; DuBose, Joseph J.; Scalea, Thomas M.; Holcomb, John B.; Shrestha, Binod; Okoye, Obi; Inaba, Kenji; Bee, Tiffany K.; Fabian, Timothy C.; Whelan, James F.; Ivatury, Rao R.; Konstantinidis, Agathoklis; Menaker, Jay; Goldberg, Stephanie R.; Zielinski, Martin D.; Jenkins, Donald; Rowe, Stephen; Alley, Darrell; Berne, John; Allen, Ladonna; Pieri, Paola G.; Haney, Starre; Claridge, Jeffrey A.; Kelly, Katherine; Coimbra, Raul; Doucet, Jay; Coopwood, Ben; Keith, David; Brown, Carlos; Haan, James M.; Ward, Jeanette; Leon, Stuart M.; Erriksson, Evert; Couillard, Debbie; De Moya, Marc A.; Van Der Wilden, Gwendolyn M.

In: JAMA Surgery, Vol. 148, No. 10, 10.2013, p. 947-954.

Research output: Contribution to journalArticle

Bradley, MJ, DuBose, JJ, Scalea, TM, Holcomb, JB, Shrestha, B, Okoye, O, Inaba, K, Bee, TK, Fabian, TC, Whelan, JF, Ivatury, RR, Konstantinidis, A, Menaker, J, Goldberg, SR, Zielinski, MD, Jenkins, D, Rowe, S, Alley, D, Berne, J, Allen, L, Pieri, PG, Haney, S, Claridge, JA, Kelly, K, Coimbra, R, Doucet, J, Coopwood, B, Keith, D, Brown, C, Haan, JM, Ward, J, Leon, SM, Erriksson, E, Couillard, D, De Moya, MA & Van Der Wilden, GM 2013, 'Independent predictors of enteric fistula and abdominal sepsis after damage control laparotomy: Results from the prospective AAST open abdomen registry', JAMA Surgery, vol. 148, no. 10, pp. 947-954. https://doi.org/10.1001/jamasurg.2013.2514
Bradley, Matthew J. ; DuBose, Joseph J. ; Scalea, Thomas M. ; Holcomb, John B. ; Shrestha, Binod ; Okoye, Obi ; Inaba, Kenji ; Bee, Tiffany K. ; Fabian, Timothy C. ; Whelan, James F. ; Ivatury, Rao R. ; Konstantinidis, Agathoklis ; Menaker, Jay ; Goldberg, Stephanie R. ; Zielinski, Martin D. ; Jenkins, Donald ; Rowe, Stephen ; Alley, Darrell ; Berne, John ; Allen, Ladonna ; Pieri, Paola G. ; Haney, Starre ; Claridge, Jeffrey A. ; Kelly, Katherine ; Coimbra, Raul ; Doucet, Jay ; Coopwood, Ben ; Keith, David ; Brown, Carlos ; Haan, James M. ; Ward, Jeanette ; Leon, Stuart M. ; Erriksson, Evert ; Couillard, Debbie ; De Moya, Marc A. ; Van Der Wilden, Gwendolyn M. / Independent predictors of enteric fistula and abdominal sepsis after damage control laparotomy : Results from the prospective AAST open abdomen registry. In: JAMA Surgery. 2013 ; Vol. 148, No. 10. pp. 947-954.
@article{c38db793ca3e494a9423bf1ebbdb8bce,
title = "Independent predictors of enteric fistula and abdominal sepsis after damage control laparotomy: Results from the prospective AAST open abdomen registry",
abstract = "IMPORTANCE Enterocutaneous fistula (ECF), enteroatmospheric fistula (EAF), and intra-abdominal sepsis/abscess (IAS) are major challenges for surgeons caring for patients undergoing damage control laparotomy after trauma. OBJECTIVE To determine independent predictors of ECF, EAF, or IAS in patients undergoing damage control laparotomy after trauma, using the AAST Open Abdomen Registry. DESIGN The AAST Open Abdomen registry of patients with an open abdomen following damage control laparotomy was used to identify patients who developed ECF, EAF, or IAS and to compare these patients with those without these complications. Univariate analyses were performed to compare these groups of patients. Variables from univariate analyses differing at P < .20 were entered into a stepwise logistic regression model to identify independent risk factors for ECF, EAF, or IAS. SETTING Fourteen level I trauma centers. PARTICIPANTS A total of 517 patients with an open abdomen following damage control laparotomy. MAIN OUTCOMES AND MEASURES Complication of ECF, EAF, or IAS. RESULTS More patients in the ECF/EAF/IAS group than in the group without these complications underwent bowel resection (63 of 111 patients [57{\%}] vs 133 of 406 patients [33{\%}]; P < .001). Within the first 48 hours after surgery, the ECF/EAF/IAS group received more colloids (P < .03) and total fluids (P < .03) than did the group without these complications. The ECF/EAF/IAS group underwent almost twice as many abdominal reexplorations as did the group without these complications (mean [SD] number, 4.1 [4.1] vs 2.2 [3.4]; P < .001). After multivariate analysis, the independent predictors of ECF/EAF/IAS were a large bowel resection (adjusted odds ratio [AOR], 3.56 [95{\%}CI, 1.88-6.76]; P < .001), a total fluid intake at 48 hours of between 5 and 10 L (AOR, 2.11 [95{\%}CI, 1.15-3.88]; P = .02)or more than 10 L (AOR, 1.93 [95{\%}CI, 1.04-3.57]; P = .04), and an increasing number of reexplorations (AOR, 1.14 [95{\%}CI, 1.06-1.21]; P < .001). CONCLUSIONS AND RELEVANCE Large bowel resection, large-volume fluid resuscitation, and an increasing number of abdominal reexplorations were statistically significant predictors of ECF, EAF, or IAS in patients with an open abdomen after damage control laparotomy.",
author = "Bradley, {Matthew J.} and DuBose, {Joseph J.} and Scalea, {Thomas M.} and Holcomb, {John B.} and Binod Shrestha and Obi Okoye and Kenji Inaba and Bee, {Tiffany K.} and Fabian, {Timothy C.} and Whelan, {James F.} and Ivatury, {Rao R.} and Agathoklis Konstantinidis and Jay Menaker and Goldberg, {Stephanie R.} and Zielinski, {Martin D.} and Donald Jenkins and Stephen Rowe and Darrell Alley and John Berne and Ladonna Allen and Pieri, {Paola G.} and Starre Haney and Claridge, {Jeffrey A.} and Katherine Kelly and Raul Coimbra and Jay Doucet and Ben Coopwood and David Keith and Carlos Brown and Haan, {James M.} and Jeanette Ward and Leon, {Stuart M.} and Evert Erriksson and Debbie Couillard and {De Moya}, {Marc A.} and {Van Der Wilden}, {Gwendolyn M.}",
year = "2013",
month = "10",
doi = "10.1001/jamasurg.2013.2514",
language = "English (US)",
volume = "148",
pages = "947--954",
journal = "JAMA Surgery",
issn = "2168-6254",
publisher = "American Medical Association",
number = "10",

}

TY - JOUR

T1 - Independent predictors of enteric fistula and abdominal sepsis after damage control laparotomy

T2 - Results from the prospective AAST open abdomen registry

AU - Bradley, Matthew J.

AU - DuBose, Joseph J.

AU - Scalea, Thomas M.

AU - Holcomb, John B.

AU - Shrestha, Binod

AU - Okoye, Obi

AU - Inaba, Kenji

AU - Bee, Tiffany K.

AU - Fabian, Timothy C.

AU - Whelan, James F.

AU - Ivatury, Rao R.

AU - Konstantinidis, Agathoklis

AU - Menaker, Jay

AU - Goldberg, Stephanie R.

AU - Zielinski, Martin D.

AU - Jenkins, Donald

AU - Rowe, Stephen

AU - Alley, Darrell

AU - Berne, John

AU - Allen, Ladonna

AU - Pieri, Paola G.

AU - Haney, Starre

AU - Claridge, Jeffrey A.

AU - Kelly, Katherine

AU - Coimbra, Raul

AU - Doucet, Jay

AU - Coopwood, Ben

AU - Keith, David

AU - Brown, Carlos

AU - Haan, James M.

AU - Ward, Jeanette

AU - Leon, Stuart M.

AU - Erriksson, Evert

AU - Couillard, Debbie

AU - De Moya, Marc A.

AU - Van Der Wilden, Gwendolyn M.

PY - 2013/10

Y1 - 2013/10

N2 - IMPORTANCE Enterocutaneous fistula (ECF), enteroatmospheric fistula (EAF), and intra-abdominal sepsis/abscess (IAS) are major challenges for surgeons caring for patients undergoing damage control laparotomy after trauma. OBJECTIVE To determine independent predictors of ECF, EAF, or IAS in patients undergoing damage control laparotomy after trauma, using the AAST Open Abdomen Registry. DESIGN The AAST Open Abdomen registry of patients with an open abdomen following damage control laparotomy was used to identify patients who developed ECF, EAF, or IAS and to compare these patients with those without these complications. Univariate analyses were performed to compare these groups of patients. Variables from univariate analyses differing at P < .20 were entered into a stepwise logistic regression model to identify independent risk factors for ECF, EAF, or IAS. SETTING Fourteen level I trauma centers. PARTICIPANTS A total of 517 patients with an open abdomen following damage control laparotomy. MAIN OUTCOMES AND MEASURES Complication of ECF, EAF, or IAS. RESULTS More patients in the ECF/EAF/IAS group than in the group without these complications underwent bowel resection (63 of 111 patients [57%] vs 133 of 406 patients [33%]; P < .001). Within the first 48 hours after surgery, the ECF/EAF/IAS group received more colloids (P < .03) and total fluids (P < .03) than did the group without these complications. The ECF/EAF/IAS group underwent almost twice as many abdominal reexplorations as did the group without these complications (mean [SD] number, 4.1 [4.1] vs 2.2 [3.4]; P < .001). After multivariate analysis, the independent predictors of ECF/EAF/IAS were a large bowel resection (adjusted odds ratio [AOR], 3.56 [95%CI, 1.88-6.76]; P < .001), a total fluid intake at 48 hours of between 5 and 10 L (AOR, 2.11 [95%CI, 1.15-3.88]; P = .02)or more than 10 L (AOR, 1.93 [95%CI, 1.04-3.57]; P = .04), and an increasing number of reexplorations (AOR, 1.14 [95%CI, 1.06-1.21]; P < .001). CONCLUSIONS AND RELEVANCE Large bowel resection, large-volume fluid resuscitation, and an increasing number of abdominal reexplorations were statistically significant predictors of ECF, EAF, or IAS in patients with an open abdomen after damage control laparotomy.

AB - IMPORTANCE Enterocutaneous fistula (ECF), enteroatmospheric fistula (EAF), and intra-abdominal sepsis/abscess (IAS) are major challenges for surgeons caring for patients undergoing damage control laparotomy after trauma. OBJECTIVE To determine independent predictors of ECF, EAF, or IAS in patients undergoing damage control laparotomy after trauma, using the AAST Open Abdomen Registry. DESIGN The AAST Open Abdomen registry of patients with an open abdomen following damage control laparotomy was used to identify patients who developed ECF, EAF, or IAS and to compare these patients with those without these complications. Univariate analyses were performed to compare these groups of patients. Variables from univariate analyses differing at P < .20 were entered into a stepwise logistic regression model to identify independent risk factors for ECF, EAF, or IAS. SETTING Fourteen level I trauma centers. PARTICIPANTS A total of 517 patients with an open abdomen following damage control laparotomy. MAIN OUTCOMES AND MEASURES Complication of ECF, EAF, or IAS. RESULTS More patients in the ECF/EAF/IAS group than in the group without these complications underwent bowel resection (63 of 111 patients [57%] vs 133 of 406 patients [33%]; P < .001). Within the first 48 hours after surgery, the ECF/EAF/IAS group received more colloids (P < .03) and total fluids (P < .03) than did the group without these complications. The ECF/EAF/IAS group underwent almost twice as many abdominal reexplorations as did the group without these complications (mean [SD] number, 4.1 [4.1] vs 2.2 [3.4]; P < .001). After multivariate analysis, the independent predictors of ECF/EAF/IAS were a large bowel resection (adjusted odds ratio [AOR], 3.56 [95%CI, 1.88-6.76]; P < .001), a total fluid intake at 48 hours of between 5 and 10 L (AOR, 2.11 [95%CI, 1.15-3.88]; P = .02)or more than 10 L (AOR, 1.93 [95%CI, 1.04-3.57]; P = .04), and an increasing number of reexplorations (AOR, 1.14 [95%CI, 1.06-1.21]; P < .001). CONCLUSIONS AND RELEVANCE Large bowel resection, large-volume fluid resuscitation, and an increasing number of abdominal reexplorations were statistically significant predictors of ECF, EAF, or IAS in patients with an open abdomen after damage control laparotomy.

UR - http://www.scopus.com/inward/record.url?scp=84886376584&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84886376584&partnerID=8YFLogxK

U2 - 10.1001/jamasurg.2013.2514

DO - 10.1001/jamasurg.2013.2514

M3 - Article

C2 - 23965658

AN - SCOPUS:84886376584

VL - 148

SP - 947

EP - 954

JO - JAMA Surgery

JF - JAMA Surgery

SN - 2168-6254

IS - 10

ER -