SP10.1.11 What happens when you VAC?

Abstract

Abstract Aims Abdominal VAC dressings are part of the surgical armamentarium in the management of the open abdomen. This study examined the number, indication and outcomes of patients with VAC dressings in a tertiary surgical unit. Methods Retrospective review of the operating theatre database identified all patients with abdominal VAC dressing between February 2016 and July 2021. Medical records were reviewed for demographics, operative, outcome and discharge data. Results 76 patients had abdominal VAC dressings. 40 (53%) were female and 57 (75%) were aged >50 years. For 54 (72%) the primary surgery was an emergency. Major indications for VAC included intra-abdominal sepsis 41 (53.9%) and wound dehiscence 16 (21.1%). Mean VAC changes under GA 2.07 (range 0–10). Mean VAC changes on the ward 2.1 (range 0–11). Mean length of hospital stay 48.6 days (range 4–258). 49 (70%) had the VAC removed in hospital, in this cohort mean duration of VAC therapy was 22 days. 11 (15%) were discharged to community hospitals and 56 (77%) directly home. 4 (5.3%) patients developed entero-atmospheric fistulae, 1 (1.3%) bleeding and 1 (1.3%) wound infection. Conclusions Abdominal VAC therapy is safe. However, it comes with significant immediate and medium-term burdens, in terms of hospital bed days, theatre time and specialist staff input, all of which are costly. Longer term, incisional hernias are associated with morbidity for patients and a financial cost for the Trust. The authors therefore advocate an attempt at early fascial closure where possible, through techniques such as mesh mediated fascial closure.