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Open abdomen closure methods for severe abdominal sepsis: a retrospective cohort study

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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Purpose

The open abdomen (OA) procedure as part of damage control surgery represents a significant surgical advance in severe intra-abdominal infections. Major techniques used for OA are negative pressure wound therapy (NPWT) and non-NPWT. The aim of this retrospective study is to evaluate the effects of different abdominal closure methods and their outcomes in patients presenting with abdominal sepsis treated with OA.

Materials and methods

We retrospectively analyzed clinical outcomes of patients affected by severe intra-abdominal sepsis treated with OA. Demographic features, mortality prediction score, abdominal closure methods, length of hospital stay, complications and mortality rates of patients were determined and compared.

Results

This study included 106 patients, of whom 77 underwent OA with NPWT and 29 with non-NPWT. OA duration was longer in NPWT patients (p = 0.007). In-hospital mortality rates in NPWT and in non-NPWT patients were 40.3% and 51.7%, respectively (p = 0.126), with an overall 30-day mortality rate of 18.2% and 51.7%, respectively (p = 0.0002). After emergency colorectal surgery, patients who underwent OA with NPWT had a lower rate of colostomy (p = 0.025).

Conclusions

NPWT is the best temporary abdominal closure technique to decrease mortality and colostomy rates in patients managed with OA for severe intra-abdominal infections.

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Abbreviations

ACS:

Abdominal compartment syndrome

APACHE:

Acute Physiologic Assessment and Chronic Health Evaluation

CIAOW:

Complicated Intra-Abdominal Infections Worldwide Observational

DCS:

Damage control surgery

DFC:

Definitive fascial closure

EAF:

Entero-atmospheric fistula

IAH:

Intra-abdominal hypertension

IAI:

Intra-abdominal infections

IAP:

Intra-abdominal pressure

ICU:

Intensive care unit

MPI:

Mannheim Peritonitis Index

NPWT:

Negative pressure wound therapy

OA:

Open abdomen

SIRS:

Systemic inflammatory response syndrome

SOFA:

Sequential Organ Failure Assessment

TAC:

Temporary abdominal closure

WBC:

White blood cell

WSACS:

World Society of the Abdominal Compartment Syndrome

WSES:

World Society of Emergency Surgery

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Acknowledgements

The authors thank Dr. David C. Nilson, Ph.D., for revising the English.

Funding

This research received no specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Department of General and Specialized Surgery “Paride Stefanini”, Policlinico Universitario Umberto I, Viale del Policlinico, 155, 00161, Rome, Italy

    Gaetano Poillucci

  2. Department of General, Emergency and Minimally Invasive Surgery, Policlinico Universitario “D. Casula”, University of Cagliari, Monserrato, Italy

    Mauro Podda

  3. Department of General Surgery, San Camillo De Lellis Hospital, Rieti, Italy

    Giulia Russo

  4. Department of General Surgery, San Giovanni Addolorata Hospital, Rome, Italy

    Sergio Gaetano Perri, Domenico Ipri, Gabriele Manetti, Maria Giulia Lolli & Renato De Angelis

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  1. Gaetano Poillucci
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Contributions

GP study conception and design, literature search, data acquisition, interpretation and analysis; drafting and critically revising the article for important intellectual content; editing and revising the English for the final version to be published; final approval of the version to be published. MP literature search, data interpretation and analysis; drafting and critically revising the article for important intellectual content; final approval of the version to be published. GR data interpretation and analysis; drafting and critically revising the article for important intellectual content; and final approval of the version to be published. SGP data interpretation and analysis; drafting and critically revising the article for important intellectual content; and final approval of the version to be published. DI data acquisition, interpretation and analysis; drafting and critically revising the article for important intellectual content; final approval of the version to be published. GM data interpretation and analysis; critically revising the article for important intellectual content; and final approval of the version to be published. MGL data interpretation and analysis; drafting and critically revising the article for important intellectual content; final approval of the version to be published. RDA study conception and design, literature search, data acquisition, interpretation and analysis; drafting and critically revising the article for important intellectual content; final approval of the version to be published.

Corresponding author

Correspondence to Gaetano Poillucci.

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Conflict of interest

Gaetano Poillucci, Mauro Podda, Giulia Russo, Sergio Gaetano Perri, Domenico Ipri, Gabriele Manetti, Maria Giulia Lolli, and Renato De Angelis have no conflict of interest to declare.

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Poillucci, G., Podda, M., Russo, G. et al. Open abdomen closure methods for severe abdominal sepsis: a retrospective cohort study. Eur J Trauma Emerg Surg 47, 1819–1825 (2021). https://doi.org/10.1007/s00068-020-01379-0

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  • DOI: https://doi.org/10.1007/s00068-020-01379-0

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