Factors influencing the fascial closure rate after open abdomen treatment: Results from the European Hernia Society (EuraHS) Registry

Arnulf Willms ,Dario Tartaglia ,Christian Beltzer ,Frank Brennfleck ,Martin Björck ,Martin W Von Websky ,René H Fortelny ,Dirk R Bulian ,Robert Schwab ,Christoph‐Thomas Germer ,Karl Sörelius ,T Monchal ,Frederik Berrevoet ,Johan Friso Lock

doi:10.1007/s10029-020-02336-x

Abstract

PurposeDefinitive fascial closure is an essential treatment objective after open abdomen treatment and mitigates morbidity and mortality. There is a paucity of evidence on factors that promote or prevent definitive fascial closure.MethodsA multi-center multivariable analysis of data from the Open Abdomen Route of the European Hernia Society included all cases between 1 May 2015 and 31 December 2019. Different treatment elements, i.e. the use of a visceral protective layer, negative-pressure wound therapy and dynamic closure techniques, as well as patient characteristics were included in the multivariable analysis. The study was registered in the International Clinical Trials Registry Platform via the German Registry for Clinical Trials (DRK00021719).ResultsData were included from 630 patients from eleven surgical departments in six European countries. Indications for OAT were peritonitis (46%), abdominal compartment syndrome (20.5%), burst abdomen (11.3%), abdominal trauma (9%), and other conditions (13.2%). The overall definitive fascial closure rate was 57.5% in the intention-to-treat analysis and 71% in the per-protocol analysis. The multivariable analysis showed a positive correlation of negative-pressure wound therapy (odds ratio: 2.496, p < 0.001) and dynamic closure techniques (odds ratio: 2.687, p < 0.001) with fascial closure and a negative correlation of intra-abdominal contamination (odds ratio: 0.630, p = 0.029) and the number of surgical procedures before OAT (odds ratio: 0.740, p = 0.005) with DFC.ConclusionThe clinical course and prognosis of open abdomen treatment can significantly be improved by the use of treatment elements such as negative-pressure wound therapy and dynamic closure techniques, which are associated with definitive fascial closure.

Highlights

Open abdomen treatment (OAT) involves the deliberate decision not to close the fascia at the end of laparotomy [1, 2]
The main objective once the abdominal situation is under control is to achieve definitive fascial closure (DFC) as soon as possible to decrease secondary morbidity since early DFC is associated with lower mortality and complication rates [9,10,11]
Since 1 May 2015, every hospital can enter data online into the Open Abdomen Route, which is a registry of the European Hernia Society (EHS) that was established as a module of the European Registry of Abdominal Wall Hernias (EuraHS – www.eurahs.eu)

Summary

Introduction

Open abdomen treatment (OAT) involves the deliberate decision not to close the fascia at the end of laparotomy [1, 2]. This surgical strategy is used in the management of critically ill patients with serious intra-abdominal conditions [3,4,5], e.g. severe secondary peritonitis, abdominal trauma, or abdominal compartment syndrome. The main objective once the abdominal situation is under control is to achieve definitive fascial closure (DFC) (i.e. definitive fascial closure) as soon as possible to decrease secondary morbidity since early DFC is associated with lower mortality and complication rates [9,10,11]

Methods

Results

Conclusion