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.
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U2 - 10.1001/jamasurg.2013.2514
DO - 10.1001/jamasurg.2013.2514
M3 - Article
C2 - 23965658
AN - SCOPUS:84886376584
SN - 2168-6254
VL - 148
SP - 947
EP - 954
JO - JAMA Surgery
JF - JAMA Surgery
IS - 10
ER -