Timing of Laparotomy and Closure in Burn Patients with Abdominal Compartment Syndrome: Effects on Survival

Abstract

Survival of burn patients with abdominal compartment syndrome (ACS) is uniformly reported to be poor, averaging just 16% after laparotomy. We hypothesize that better outcomes can be achieved with a strategy of immediate laparotomy and early fascial closure. Patients with burn injury who were diagnosed with ACS between 2005 and 2016 were identified through a search of databases. Data were gathered from electronic medical records. Timing of laparotomy and closure were calculated for each patient. Patients were stratified into predefined groups based on timing of laparotomy, cause of ACS, patient age, and timing of abdominal closure. Survival rates were calculated and compared. Forty-six patients with burn injury and ACS were identified. Abdominal compartment syndrome developed during initial resuscitation in 27 patients, during perioperative resuscitation in 5 patients, and during an episode of sepsis in 13 patients. Overall survival was 56%. Mean time to laparotomy from diagnosis of ACS was 1 hour 8 minutes (SD 59 minutes). When ACS developed in patients during initial resuscitation, the mean time to laparotomy from hospital admission was 13 hours (SD 7 hours). Survival rate in this group was 70%, and survival rate in patients treated for ACS later in their hospital course was 33% (p= 0.03). Survival among patients whose laparotomy was closed within 48 hours was 100%, and survival among patients whose laparotomy was not closed within 48 hours was 48% (p= 0.01). Immediate laparotomy resulted in much higher survival rates than previously reported in burn patients with ACS. Survival was higher when ACS was diagnosed during initial resuscitation. Fascial closure within 48 hours was associated with improved survival compared with later fascial closure.