Prognostic Factors of Open Abdomen Treatment in Visceral Surgery

Introduction In general surgery, open abdomen treatment (OAT) is used to treat abdominal compartment syndrome (ACS) and sepsis, often after a primary surgical procedure associated with complications. The results achieved in this patient population may depend on factors that are yet unknown. This study evaluates independent patient-related prognostic factors after OAT. Methods 38 clinical parameters and survival data of 165 consecutive general surgery patients after OAT were entered into a prospective database according to a defined algorithm in order to analyse the underlying surgical pathology, predictors of survival and important aspects of OAT-related morbidity. Independent predictors of survival, OAT-related morbidity and duration of hospital stay were identified. Results Common indications for OAT were peritonitis, haemorrhage and ACS. Median age was 60 years and > 80% of patients were ASA III/IV; median follow-up was 23 months. Oncologic surgery was performed in 19% of cases. 30-day and 1-year mortality was 11% and 34%, respectively. Malignancy was a negative predictor (OR: 4.63, 95% CI: 2.00-10.7) while mild obesity (BMI 25-35) and primary fascial closure, which was achieved in 82% of patients, improved survival (OR: 0.2, 95% CI: 0.07-0.55; OR: 0.19, 95% CI: 0.06-0.57). Entero-atmospheric fistula (EAF) and giant hernia with impossible fascial closure were frequent after OAT (19 and 18%), and malignancy was an independent risk factor for EAF (OR 3.47, CI [95%]: 1.41-8.53). Vacuum-assisted wound closure or polyglactin mesh interposition did not affect EAF incidence. Conclusions General surgery patients after OAT differ significantly from trauma patients, and mortality as well as long-term morbidity is high. Outcome is greatly determined by independent patient-related factors after OAT. A tailored surgical approach based on objective evidence is needed to further improve the results after OAT.