| Abstract: Introduction
Post-operative patients returning to ICU with open abdomens following abdominal surgery pose a large clinical and socio-economic strain on health care. Few large volume series have been reported and clear guidelines to care do not exist (1,2,3). This study assessed abdominal decompression (AD) and temporary abdominal closure (TAC) at a university teaching hospital.
Method
A prospective study was undertaken between June 1993 and May 2004 at a 500 bed university hospital in all patients undergoing AD. Patients were followed from admission to hospital discharge or death. Surgery was undertaken by 14 surgeons in general, trauma and vascular surgery. Analysis included demographic data, ICU admission APACHE II scores, intra-abdominal pressure where recorded, lengths of stay and survival. Comparison between two five periods, 1994-1998 and 1999-2003 were made to assess mortality trends.
Results
128 patients (68% male), mean age 55 ±17.7 were studied. 117/128 had undergone emergency surgery, 79 for gastrointestinal problems, 36 for trauma and 14 for abdominal aortic procedures. The mean APACHE II score was 23.3 ± 7.95. The reason for the open abdomen was to facilitate management of intra-abdominal sepsis in 50, abdominal decompression in 41, inability to close the abdomen primarily in 24 and a combination of factors in 13. In the 62 patients having both pre and post-operative IAP’s performed, 49 (79%) had pre-operative IAP’s of ³16mmHG. Following TAC 22/62 had IAP’s of ³16 mmHg. 48 (37.5%) died. The overall median hospital stay was 33 days, range 1 to 532. Delayed primary abdominal closure was undertaken in 66 of the 80 survivors and a further 12 healed by secondary intention. The overall mortality was 37.5% (48/128), for 94-98 was 42% 28/67 and for 1999-2003 32% (17/53). The risk reduction in mortality was not significant at .09 (95%CI -.26,.07) (chi2 = 1.19, DF=1, p=.275).
Conclusions
Open abdomen patients form a complex group of critically ill patients, with a high mortality. Practice guidelines must encompass the diverse nature of the patient population and the surgical and critical care they receive.
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