Enteroatmospheric fistulas in open abdomen in trauma associated with abdominal reintervention and VAC therapy

Background: Open abdomen is an alternative for the management of trauma patient, and negative pressure therapy of the wound using VAC (R) device is a genuine sort of treatment. Although the device poses technical advantages, risks are present and a critical complication is the enteroatmospheric fistula formation (EAF). Objective: To analize the role of negative pressure therapy length and VAC (R) device number of changes on the EAF formation in trauma patients udergoing open abdomen. Method: Cut-off points were calculated using receiver operational characteristics curve. Values were compared with Student's t or Mann-Withney U tests, considering statistically significant p < 0.05. Results: EAF were present in 39 cases (5.9%). A significant difference in the presence of EAF was present in patients with negative pressure therapy of the wound length >_ 11.2 days (46.9 vs. 1.3%; relative risk [RR]: 3.67; 95% confidence interval [95%IC]: 2.4-6.68; p = 0.017) and when >_ 2.6 VAC (R) device changes were performed (34.6 vs. 0.5%; RR: 6.92; 95%IC: 1.1-4.3; p < 0.001). Conclusions: At our institution, the practice of >3 VAC (R) device changes and length of therapy > 11 days should be carefully considered leading to reduce the risk of EAF formation.