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Open Abdomen Treated with Negative Pressure Wound Therapy: Indications, Management and Survival
Univ Trondheim Hosp, St Olavs Hosp, Dept Vasc Surg, Prinsesse Kristinas Gate 3, N-7006 Trondheim, Norway.;Norwegian Univ Sci & Technol NTNU, Dept Canc Res, Hogskoleringen 1, N-7491 Trondheim, Norway.;Norwegian Univ Sci & Technol NTNU, Dept Mol Med, Hogskoleringen 1, N-7491 Trondheim, Norway.;Norwegian Univ Sci & Technol NTNU, Dept Circulat, N-7006 Trondheim, Norway.;Norwegian Univ Sci & Technol NTNU, Dept Med Imaging, N-7006 Trondheim, Norway..
Univ Trondheim Hosp, St Olavs Hosp, Dept Gastrointestinal Surg, Prinsesse Kristinas Gate 3, N-7006 Trondheim, Norway..
Univ Trondheim Hosp, St Olavs Hosp, Dept Anesthesiol, Prinsesse Kristinas Gate 3, N-7006 Trondheim, Norway.;Univ Trondheim Hosp, St Olavs Hosp, Dept Intens Care Med, Prinsesse Kristinas Gate 3, N-7006 Trondheim, Norway..
Univ Trondheim Hosp, St Olavs Hosp, Dept Anesthesiol, Prinsesse Kristinas Gate 3, N-7006 Trondheim, Norway.;Univ Trondheim Hosp, St Olavs Hosp, Dept Intens Care Med, Prinsesse Kristinas Gate 3, N-7006 Trondheim, Norway.;Norwegian Univ Sci & Technol NTNU, Dept Circulat, N-7006 Trondheim, Norway.;Norwegian Univ Sci & Technol NTNU, Dept Med Imaging, N-7006 Trondheim, Norway..
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2017 (English)In: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 41, no 1, 152-161 p.Article in journal (Refereed) Published
Abstract [en]

Open abdomen treatment (OAT) is a significant burden for patients and is associated with considerable mortality. The primary aim of this study was to report survival and cause of mortality after OAT. Secondary aims were to evaluate length of stay (LOS) in intensive care unit (ICU) and in hospital, time to abdominal closure and major complications. Retrospective review of prospectively registered patients undergoing OAT between October 2006 and June 2014 at Trondheim University Hospital, Norway. The 118 patients with OAT had a median age of 63 (20-88) years. OAT indications were abdominal compartment syndrome (ACS) (n = 53), prophylactic (n = 29), abdominal contamination/second look laparotomy (n = 22), necrotizing fasciitis (n = 7), hemorrhage packing (n = 4) and full-thickness wound dehiscence (n = 3). Eight percent were trauma patients. Vacuum-assisted wound closure (VAWC) with mesh-mediated traction (VAWCM) was used in 92 (78 %) patients, the remaining 26 (22 %) had VAWC only. Per-protocol primary fascial closure rate was 84 %. Median time to abdominal closure was 12 days (1-143). LOS in the ICU was 15 (1-89), and in hospital 29 (1-246) days. Eighty-one (68 %) patients survived the hospital stay. Renal failure requiring renal replacement therapy (RRT) (OR 3.9, 95 % CI 1.37-11.11), ACS (OR 3.1, 95 % CI 1.19-8.29) and advanced age (OR 1.045, 95 % CI 1.004-1.088) were independent predictors of mortality in multivariate analysis. The nine patients with an entero-atmospheric fistula (EAF) survived. Two-thirds of the patients treated with OAT survived. Renal failure with RRT, ACS and advanced age were predictors of mortality, whereas EAF was not associated with increased mortality.

Place, publisher, year, edition, pages
SPRINGER , 2017. Vol. 41, no 1, 152-161 p.
National Category
Surgery
Identifiers
URN: urn:nbn:se:uu:diva-319877DOI: 10.1007/s00268-016-3694-8ISI: 000392147000023PubMedID: 27541031OAI: oai:DiVA.org:uu-319877DiVA: diva2:1088673
Available from: 2017-04-13 Created: 2017-04-13 Last updated: 2017-04-13Bibliographically approved

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