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Revisiting abdominal closure in mesenteric ischemia: is there an association with outcome?

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

Abstract

Purpose

Current guidelines advocate liberal use of delayed abdominal closure in patients with acute mesenteric ischemia (AMI) undergoing laparotomy. Few studies have systematically examined this practice. The goal of this study was to evaluate the effect of delayed abdominal closure on postoperative morbidity and mortality in patients with AMI.

Methods

We performed a retrospective cohort study of the ACS-NSQIP 2013–2017 registry. We included patients with a diagnosis of AMI undergoing emergency laparotomy. Patients were divided into two groups based on the type of abdominal closure: (1) delayed fascial closure (DFC) when no layers of the abdominal wall were closed and (2) immediate fascial closure (IFC) if deep layers or all layers of the abdominal wall were closed. Propensity score matching was performed based on comorbidities, pre-operative, and operative characteristics. Univariable analysis was performed on the matched sample.

Results

The propensity-matched cohort consisted of 1520 patients equally divided into the DFC and IFC groups. The median (IQR) age was 68 (59–77), and 836 (55.0%) were female. Compared to IFC, the DFC group showed increased in-hospital mortality (38.9% vs. 31.6%, p = 0.002), 30-day mortality (42.4% vs. 36.3%, p = 0.012), and increased risk of respiratory failure (59.5% vs. 31.2%, p < 0.001).

Conclusions

The delayed fascial closure technique was associated with increased mortality compared to immediate fascial closure. These findings do not support the blanket incorporation of delayed closure in mesenteric ischemia care or its previously advocated liberal use.

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Data availability

The final dataset used for the analysis will be made available upon request. NSQIP is a publicly available dataset.

Abbreviations

AMI:

Acute mesenteric ischemia

NSQIP:

National Surgical Quality Improvement Program

ICD:

International Classification of Disease

CPT:

Current procedural terminology

ASA:

American Society of Anesthesiologists

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Authors and Affiliations

  1. Division of Trauma, Emergency Surgery and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, 165 Cambridge St, Suite 810, Boston, MA, 02114, USA

    Jefferson A. Proaño-Zamudio, Dias Argandykov, Angela Renne, Anthony Gebran, Ander Dorken-Gallastegi, Charudutt N. Paranjape, Haytham M. A. Kaafarani, David R. King, George C. Velmahos & John O. Hwabejire

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  1. Jefferson A. Proaño-Zamudio
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  2. Dias Argandykov
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  3. Angela Renne
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Contributions

JAP-Z contributed to conceptualization, methodology, formal analysis, investigation, writing and review. DA contributed to conceptualization, formal analysis, writing and review. AR contributed to formal analysis, writing and review. AG contributed to conceptualization, methodology, formal analysis. AD-G contributed to methodology, writing and review, supervision. CNP contributed to writing and review, supervision. HMAK contributed to investigation, methodology, writing and review, supervision. DRK contributed to investigation, methodology, writing and review, supervision. GCV contributed to investigation, methodology, writing and review, supervision. JOH contributed to conceptualization, investigation, methodology, writing and review, supervision.

Corresponding author

Correspondence to John O. Hwabejire.

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The authors have no relevant financial or non-financial interests to disclose.

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Proaño-Zamudio, J.A., Argandykov, D., Renne, A. et al. Revisiting abdominal closure in mesenteric ischemia: is there an association with outcome?. Eur J Trauma Emerg Surg 49, 2017–2024 (2023). https://doi.org/10.1007/s00068-022-02199-0

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