Nontrauma open abdomens: A prospective observational study

Brandon R. Bruns, Sarwat A. Ahmad, Lindsay O'Meara, Ronald Tesoriero, Margaret Lauerman, Elena Klyushnenkova, Rosemary Kozar, Thomas M. Scalea, Jose J. Diaz

Research output: Contribution to journalArticlepeer-review

31 Scopus citations

Abstract

Background: 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 OAwill be varied. METHODS: 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. RESULTS: A total of 338 laparotomieswere performed, of which 96 (28%)weremanaged with an OA.Median agewas 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 OAwas damage control (37%). In the 63 patients with fascial closure, there were 9 (14%) wound infections and 6 (10%) fascial dehiscences.Atotal of 30%of the patients died in the hospital, and an additional six patients died 6months after discharge. Patients in the oldest age stratum were more likely to die at 6 months than those in the lower strata. CONCLUSION: Older patients were more likely to die by 6 months, the median hospital stay was 3 weeks, and there were multiple indications for OAmanagement.With a 6-monthmortality of 36%and 70% of survivors requiring postdischarge care, this population represents a critically ill population meriting additional study.

Original languageEnglish (US)
Pages (from-to)631-636
Number of pages6
JournalJournal of Trauma and Acute Care Surgery
Volume80
Issue number4
DOIs
StatePublished - 2016
Externally publishedYes

Keywords

  • Acute care surgery
  • Damage control
  • Emergency surgery
  • Open abdomen

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

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