Management of the open abdomen

A national study of clinical outcome and safety of negative pressure wound therapy

Gordon L. Carlson*, Hannah Patrick, Amin I. Amin, Gladys McPherson, Graeme Maclennan, Ebenezer Afolabi, Graham Mowatt, Bruce Campbell

*Corresponding author for this work

Research output: Contribution to journalArticle

67 Citations (Scopus)

Abstract

Objective: To determine clinical outcome of open abdomen therapy and assess the influence of negative pressure wound therapy on outcome. Background: Leaving the abdomen open (laparostomy) is an option following laparotomy for severe abdominal sepsis or trauma. Negative pressure wound therapy (NPWT) has become a popular means of managing laparostomywounds. Itmay facilitate nursing care and delayed primarywound closure but the evidence to support its use is poor and concern has arisen about the risk of intestinal fistulation from exposed bowel, leading to an increased risk of death. Methods: Prospective observational study of 578 patients treated with an open abdomen in 105 hospitals in the United Kingdom between January 1, 2010, and June 30, 2011. Propensity analysis was used to compare adverse outcomes (fistulation, death, intestinal failure, bleeding requiring intervention) and delayed primary closure rates in patients who did and did not receive NPWT. Findings: The most common indication for an open abdomen (n = 398, 68.9%) was abdominal sepsis. Overall hospital mortality was 28.2%. The majority of patients (n = 355, 61.4%) were treated with NPWT. Intestinal fistulation [relative risk (RR) = 0.83, 95% confidence interval (CI): 0.44-1.58], death (RR = 0.87, 95% CI: 0.64-1.20), bleeding (RR = 0.74, 95% CI: 0.45-1.23), and intestinal failure (RR = 1.00, 95% CI: 0.64-1.57) were no more common in patients receiving NPWT, but the rate of delayed primary closure was significantly lower (RR = 0.74, 95% CI: 0.60-0.90, P = 0.002) when NPWT was used. Conclusions: The indications for an open abdomen in the United Kingdom appear to be significantly different to those described in N. America, where its use in the management of trauma predominates. NPWT in patients with an open abdomen is not associated with an increase in mortality or intestinal fistulation. It is, however, associated with a reduced rate of delayed primary closure. Although this may be related to patient selection, NPWT may leave patients with abdominal wall defects that require further treatment.

Original languageEnglish
Pages (from-to)1154-1159
Number of pages6
JournalAnnals of Surgery
Volume257
Issue number6
DOIs
Publication statusPublished - 1 Jun 2013

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Negative-Pressure Wound Therapy
Abdomen
Outcome Assessment (Health Care)
Safety
Confidence Intervals
Sepsis
Hemorrhage
Clinical Studies
Wounds and Injuries
Abdominal Wall
Nursing Care
Hospital Mortality
Laparotomy
Patient Selection
Observational Studies
Prospective Studies
Mortality

Keywords

  • Abdominal compartment syndrome
  • Abdominal wall reconstruction
  • Intestinal failure
  • Intestinal fistula
  • Laparostomy
  • Negative pressure wound therapy
  • Sepsis

ASJC Scopus subject areas

  • Surgery

Cite this

Management of the open abdomen : A national study of clinical outcome and safety of negative pressure wound therapy. / Carlson, Gordon L.; Patrick, Hannah; Amin, Amin I.; McPherson, Gladys; Maclennan, Graeme; Afolabi, Ebenezer; Mowatt, Graham; Campbell, Bruce.

In: Annals of Surgery, Vol. 257, No. 6, 01.06.2013, p. 1154-1159.

Research output: Contribution to journalArticle

Carlson, GL, Patrick, H, Amin, AI, McPherson, G, Maclennan, G, Afolabi, E, Mowatt, G & Campbell, B 2013, 'Management of the open abdomen: A national study of clinical outcome and safety of negative pressure wound therapy', Annals of Surgery, vol. 257, no. 6, pp. 1154-1159. https://doi.org/10.1097/SLA.0b013e31828b8bc8
Carlson, Gordon L. ; Patrick, Hannah ; Amin, Amin I. ; McPherson, Gladys ; Maclennan, Graeme ; Afolabi, Ebenezer ; Mowatt, Graham ; Campbell, Bruce. / Management of the open abdomen : A national study of clinical outcome and safety of negative pressure wound therapy. In: Annals of Surgery. 2013 ; Vol. 257, No. 6. pp. 1154-1159.
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abstract = "Objective: To determine clinical outcome of open abdomen therapy and assess the influence of negative pressure wound therapy on outcome. Background: Leaving the abdomen open (laparostomy) is an option following laparotomy for severe abdominal sepsis or trauma. Negative pressure wound therapy (NPWT) has become a popular means of managing laparostomywounds. Itmay facilitate nursing care and delayed primarywound closure but the evidence to support its use is poor and concern has arisen about the risk of intestinal fistulation from exposed bowel, leading to an increased risk of death. Methods: Prospective observational study of 578 patients treated with an open abdomen in 105 hospitals in the United Kingdom between January 1, 2010, and June 30, 2011. Propensity analysis was used to compare adverse outcomes (fistulation, death, intestinal failure, bleeding requiring intervention) and delayed primary closure rates in patients who did and did not receive NPWT. Findings: The most common indication for an open abdomen (n = 398, 68.9{\%}) was abdominal sepsis. Overall hospital mortality was 28.2{\%}. The majority of patients (n = 355, 61.4{\%}) were treated with NPWT. Intestinal fistulation [relative risk (RR) = 0.83, 95{\%} confidence interval (CI): 0.44-1.58], death (RR = 0.87, 95{\%} CI: 0.64-1.20), bleeding (RR = 0.74, 95{\%} CI: 0.45-1.23), and intestinal failure (RR = 1.00, 95{\%} CI: 0.64-1.57) were no more common in patients receiving NPWT, but the rate of delayed primary closure was significantly lower (RR = 0.74, 95{\%} CI: 0.60-0.90, P = 0.002) when NPWT was used. Conclusions: The indications for an open abdomen in the United Kingdom appear to be significantly different to those described in N. America, where its use in the management of trauma predominates. NPWT in patients with an open abdomen is not associated with an increase in mortality or intestinal fistulation. It is, however, associated with a reduced rate of delayed primary closure. Although this may be related to patient selection, NPWT may leave patients with abdominal wall defects that require further treatment.",
keywords = "Abdominal compartment syndrome, Abdominal wall reconstruction, Intestinal failure, Intestinal fistula, Laparostomy, Negative pressure wound therapy, Sepsis",
author = "Carlson, {Gordon L.} and Hannah Patrick and Amin, {Amin I.} and Gladys McPherson and Graeme Maclennan and Ebenezer Afolabi and Graham Mowatt and Bruce Campbell",
note = "The authors thank colleagues, including clinical audit managers, surgeons, intensivists, anesthetists, tissue viability and other nursing staff who contributed information to the study, and those who reviewed records to identify suitable patients. They are grateful to Heather Newton, Tissue Viability Nurse Consultant at the Royal Cornwall Hospitals, and Suzie Peden, technical analyst at NICE, for their help in launching the project. They also thank Professor Kathy Rowan and David Harrison of ICNARC for helping to promote data submission and to all units that contribute to the FIRE and CMP databases.",
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TY - JOUR

T1 - Management of the open abdomen

T2 - A national study of clinical outcome and safety of negative pressure wound therapy

AU - Carlson, Gordon L.

AU - Patrick, Hannah

AU - Amin, Amin I.

AU - McPherson, Gladys

AU - Maclennan, Graeme

AU - Afolabi, Ebenezer

AU - Mowatt, Graham

AU - Campbell, Bruce

N1 - The authors thank colleagues, including clinical audit managers, surgeons, intensivists, anesthetists, tissue viability and other nursing staff who contributed information to the study, and those who reviewed records to identify suitable patients. They are grateful to Heather Newton, Tissue Viability Nurse Consultant at the Royal Cornwall Hospitals, and Suzie Peden, technical analyst at NICE, for their help in launching the project. They also thank Professor Kathy Rowan and David Harrison of ICNARC for helping to promote data submission and to all units that contribute to the FIRE and CMP databases.

PY - 2013/6/1

Y1 - 2013/6/1

N2 - Objective: To determine clinical outcome of open abdomen therapy and assess the influence of negative pressure wound therapy on outcome. Background: Leaving the abdomen open (laparostomy) is an option following laparotomy for severe abdominal sepsis or trauma. Negative pressure wound therapy (NPWT) has become a popular means of managing laparostomywounds. Itmay facilitate nursing care and delayed primarywound closure but the evidence to support its use is poor and concern has arisen about the risk of intestinal fistulation from exposed bowel, leading to an increased risk of death. Methods: Prospective observational study of 578 patients treated with an open abdomen in 105 hospitals in the United Kingdom between January 1, 2010, and June 30, 2011. Propensity analysis was used to compare adverse outcomes (fistulation, death, intestinal failure, bleeding requiring intervention) and delayed primary closure rates in patients who did and did not receive NPWT. Findings: The most common indication for an open abdomen (n = 398, 68.9%) was abdominal sepsis. Overall hospital mortality was 28.2%. The majority of patients (n = 355, 61.4%) were treated with NPWT. Intestinal fistulation [relative risk (RR) = 0.83, 95% confidence interval (CI): 0.44-1.58], death (RR = 0.87, 95% CI: 0.64-1.20), bleeding (RR = 0.74, 95% CI: 0.45-1.23), and intestinal failure (RR = 1.00, 95% CI: 0.64-1.57) were no more common in patients receiving NPWT, but the rate of delayed primary closure was significantly lower (RR = 0.74, 95% CI: 0.60-0.90, P = 0.002) when NPWT was used. Conclusions: The indications for an open abdomen in the United Kingdom appear to be significantly different to those described in N. America, where its use in the management of trauma predominates. NPWT in patients with an open abdomen is not associated with an increase in mortality or intestinal fistulation. It is, however, associated with a reduced rate of delayed primary closure. Although this may be related to patient selection, NPWT may leave patients with abdominal wall defects that require further treatment.

AB - Objective: To determine clinical outcome of open abdomen therapy and assess the influence of negative pressure wound therapy on outcome. Background: Leaving the abdomen open (laparostomy) is an option following laparotomy for severe abdominal sepsis or trauma. Negative pressure wound therapy (NPWT) has become a popular means of managing laparostomywounds. Itmay facilitate nursing care and delayed primarywound closure but the evidence to support its use is poor and concern has arisen about the risk of intestinal fistulation from exposed bowel, leading to an increased risk of death. Methods: Prospective observational study of 578 patients treated with an open abdomen in 105 hospitals in the United Kingdom between January 1, 2010, and June 30, 2011. Propensity analysis was used to compare adverse outcomes (fistulation, death, intestinal failure, bleeding requiring intervention) and delayed primary closure rates in patients who did and did not receive NPWT. Findings: The most common indication for an open abdomen (n = 398, 68.9%) was abdominal sepsis. Overall hospital mortality was 28.2%. The majority of patients (n = 355, 61.4%) were treated with NPWT. Intestinal fistulation [relative risk (RR) = 0.83, 95% confidence interval (CI): 0.44-1.58], death (RR = 0.87, 95% CI: 0.64-1.20), bleeding (RR = 0.74, 95% CI: 0.45-1.23), and intestinal failure (RR = 1.00, 95% CI: 0.64-1.57) were no more common in patients receiving NPWT, but the rate of delayed primary closure was significantly lower (RR = 0.74, 95% CI: 0.60-0.90, P = 0.002) when NPWT was used. Conclusions: The indications for an open abdomen in the United Kingdom appear to be significantly different to those described in N. America, where its use in the management of trauma predominates. NPWT in patients with an open abdomen is not associated with an increase in mortality or intestinal fistulation. It is, however, associated with a reduced rate of delayed primary closure. Although this may be related to patient selection, NPWT may leave patients with abdominal wall defects that require further treatment.

KW - Abdominal compartment syndrome

KW - Abdominal wall reconstruction

KW - Intestinal failure

KW - Intestinal fistula

KW - Laparostomy

KW - Negative pressure wound therapy

KW - Sepsis

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JO - Annals of Surgery

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