Abstract
Over the past few years, the open abdomen (OA) as a part of Damage Control Surgery (DCS) has been introduced as a surgical strategy with the intent to reduce the mortality of patients with severe abdominal sepsis. Aims of our study were to analyze the OA effects on patients with abdominal sepsis and identify predictive factors of mortality. Patients admitted to our institution with abdominal sepsis requiring OA from 2010 to 2019 were retrospectively analyzed. Primary outcomes were mortality, morbidity and definitive fascial closure (DFC). Comparison between groups was made via univariate and multivariate analyses. On 1474 patients operated for abdominal sepsis, 113 (7.6%) underwent OA. Male gender accounted for 52.2% of cases. Mean age was 68.1 ± 14.3 years. ASA score was > 2 in 87.9%. Mean BMI, APACHE II score and Mannheim Peritonitis Index were 26.4 ± 4.9, 15.3 ± 6.3, and 22.6 ± 7.3, respectively. A negative pressure wound system technique was used in 47% of the cases. Overall, mortality was 43.4%, morbidity 76.6%, and DFC rate was 97.8%. Entero-atmospheric fistula rate was 2.2%. At multivariate analysis, APACHE II score (OR 1.18; 95% CI 1.05–1.32; p = 0.005), Frailty Clinical Scale (OR 4.66; 95% CI 3.19–6.12; p < 0.0001) and ASA grade IV (OR 7.86; 95% CI 2.18–28.27; p = 0.002) were significantly associated with mortality. OA seems to be a safe and reliable treatment for critically ill patients with severe abdominal sepsis. Nonetheless, in these patients, co-morbidity and organ failure remain the major obstacles to a better prognosis.
Highlights
A wide range of pathological conditions could be related to abdominal sepsis such as generalized primary or secondary peritonitis, massive intestinal infarction and severe acute pancreatitis complicated by infected necrosis
In the context of damage control surgery (DCS), open abdomen (OA) is indicated in case of septic shock, inability to control the source of infection, the need for a deferred intestinal anastomosis, loss of abdominal wall and important visceral edema leading to abdominal compartment syndrome (ACS) [1]
The present study aimed to evaluate postoperative outcomes of patients with abdominal sepsis treated with OA mainly in terms of perioperative mortality, overall morbidity and definitive fascial closure rates and to identify potential predictive factors of perioperative mortality
Summary
A wide range of pathological conditions could be related to abdominal sepsis such as generalized primary or secondary peritonitis, massive intestinal infarction and severe acute pancreatitis complicated by infected necrosis. OA could potentially be associated with several critical complications, that can lead to a high rate of mortality in such very frail category of patients. Little is in the literature focusing on the research of predictive parameters of mortality which might help surgeons to adequately select patients and choose between different therapeutic strategies. The present study aimed to evaluate postoperative outcomes of patients with abdominal sepsis treated with OA mainly in terms of perioperative mortality, overall morbidity and definitive fascial closure rates and to identify potential predictive factors of perioperative mortality
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