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Open abdomen in the trauma ICU patient: who? when? why? and what are the outcome results?

  • Original Article
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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Purpose

Temporary abdominal closure is a component of damage control surgery and may decrease mortality rates. The ultimate aim in managing an open abdomen is to achieve definitive fascial closure. The aim of this study is to assess the previously known predictors for failure to achieve definitive fascial closure and identify new predictors in order to achieve a better outcome.

Methods

An 11-year retrospective chart review included open abdomen cases at Inkosi Albert Luthuli Hospital Trauma ICU in KZN (Ethics Approval BCA207-09). The evaluated outcomes were definitive fascial closure, open abdomen and mortality. Variables included age, co-morbidities, albumin levels, renal failure, multiple blood transfusions, type of blood products given, entero-atmospheric fistulas, TAC, anastomosis, intra-abdominal abscess, type of nutrition, ACS, number of re-laparotomies, deep site infections (peritonitis), systemic infections (bloodstream), ventilator acquired pneumonia, head injury, and type of fluids given.

Results

This study reviewed 188 cases, 46.8% (88) arrived from elsewhere with an open abdomen while 53.2% (100) did not; 46.8% suffered blunt trauma, 45.2% suffered gunshots, while 8.0% were stabbed. Ninety deaths (47.9%) occurred during the index admission with 57 (30.3%) within the first 30 days. For both death within 30 days and death as final outcome, the majority were blunt abdominal trauma, 51.1 and 52.6%, respectively. Out of 188 patients, 27.1% had definitive fascial closure and 26.6% remained with an open abdomen. The relevant variables related to failure to achieve fascial closure were hypoalbuminemia (p = 0.002, p = 0.036), anastomotic leak (p < 0.05), VAP (p = 0.007), age (p = 0.002), intra-abdominal abscesses (p = 0.006), ACS (p = 0.005), multiple re-laparotomies (p = 0,028), deep surgical site infection (p < 0.05) and multi-organ failure (p = 0.003).

Conclusion

This study identified the predictors of failed fascial closure and mortality. While not directly modifiable, hypoalbuminaemia, anastomotic leak and sepsis, leading to multiple re-laparotomy, preclude early closure and portend high mortality.

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Data availability

Not publicly accessible, but available from the primary author.

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Acknowledgments

The authors thank Dr. Irashni Moodley for assistance offered and Mrs. Catherine Connolly and Tawheeda Rozbully for their statistical expertise.

Funding

Self-funded study.

Author information

Authors and Affiliations

  1. Department of Surgery, University of KwaZulu-Natal, Durban, South Africa

    Kurt Nirishan Boolaky

  2. General Surgery, Prince Mshiyeni Memorial Hospital, Umlazi, South Africa

    Ali Hassan Tariq

  3. Trauma Unit, Inkosi Albert Luthuli Central Hospital, Department of Surgery, University of KwaZulu-Natal, Durban, South Africa

    Timothy Craig Hardcastle

  4. IALCH Trauma Service, 800 Vusi Mzimela Rd, Mayville, Durban, 4055, South Africa

    Timothy Craig Hardcastle

Authors
  1. Kurt Nirishan Boolaky
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  2. Ali Hassan Tariq
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  3. Timothy Craig Hardcastle
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Contributions

KNB and TCH conceived the study and wrote the protocol, KNB and AHT undertook data collection and analysis. KNB, AHT and TCH all evaluated the results and the statistical analysis. KNB and AHT wrote the first draft and TCH undertook grammar edits and finalised the manuscript. All authors assessed and approved the final version.

Corresponding author

Correspondence to Timothy Craig Hardcastle.

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Conflict of interest

The authors declare that they have no interest to declare. This work contributes toward the degree MMed (Surgery) for the first author with the third author as the supervisor.

Additional information

This work has not been published or presented elsewhere.

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Cite this article

Boolaky, K.N., Tariq, A.H. & Hardcastle, T.C. Open abdomen in the trauma ICU patient: who? when? why? and what are the outcome results?. Eur J Trauma Emerg Surg 48, 953–961 (2022). https://doi.org/10.1007/s00068-020-01543-6

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  • DOI: https://doi.org/10.1007/s00068-020-01543-6

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