Abstract
Open abdomen indicates the abdominal fascia is unclosed to abbreviate surgery and to reduce physiological stress. However, complications and difficulties in patient care are often encountered after operation. During May 2008 to March 2013, we performed a prospective protocol-directed observation study regarding open abdomen use in trauma patients. Bogota bag is the temporary abdomen closure initially but negative pressure dressing is used later. A goal-directed ICU care is applied and primary fascial closure is the primary endpoint. There were 242 patients received laparotomy after torso trauma and 84 (34.7%) had open abdomen. Twenty patients soon died within one day and were excluded. Among the included 64 patients, there were 49 (76.6%) males and the mean Injury Severity Score was 31.7. Uncontrolled bleeding was the major indication for open abdomen (64.1%) and the average duration of open abdomen was about 4.2 ± 2.2 days. After treatment, 53(82.8%) had primary fascia closure, which is significant for patient survival (odds ratio 21.6; 95% confidence interval: 3.27–142, p = 0.0014). Factors related to failed primary fascia closure are profound shock during operation, high Sequential Organ Failure Assessment Score in ICU and inadequate urine amount at first 48 hours admission.
Highlights
Open abdomen (OA) indicates a specific surgical technique in which the abdominal fascial edges are intentionally left unapproximated after laparotomy
From May 2008 to March 2013, 2,949 patients were admitted to the Department of Trauma and Emergent Surgery at Chung Gung Memorial Hospital, Linkou, Taiwan
injury severity score (ISS) was considered important for primary fascial closure (PFC) in a study[2], our study showed more significant results for physiological parameters, such as acidosis at emergency department presentation and sequential organ failure assessment (SOFA) score at Intensive Care Unit (ICU) admission
Summary
Open abdomen (OA) indicates a specific surgical technique in which the abdominal fascial edges are intentionally left unapproximated after laparotomy. In addition to being used for abdominal trauma, OA is part of the Damage-Control Surgical (DCS) strategy for various complicated abdominal conditions, such as severe abdominal sepsis, necrotizing pancreatitis, abdominal compartment syndrome (ACS), necrotizing fasciitis of the abdominal wall, and uncontrolled bleeding in physiologically exhausted patients[3]. With the improved understanding of multiple-organ failure in trauma and ACS, damage-control laparotomy with OA is an important surgical strategy used in traumatology to provide the best results. Caring problems frequently happens including difficulties fluid balance maintenance, risk of enterocutaneous fistula, fascial retraction with loss of the abdominal domain, and significant www.nature.com/scientificreports/. Risk factors associated with failed PFC and the impact of failed PFC on patient survival after OA in major abdominal trauma are not well elucidated. We sought to identify the independent risk factors associated with PFC and the impact of failed PFC on patient outcomes
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