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 language | English |
|---|---|
| Pages (from-to) | 1154-1159 |
| Number of pages | 6 |
| Journal | Annals of Surgery |
| Volume | 257 |
| Issue number | 6 |
| DOIs | |
| Publication status | Published - 1 Jun 2013 |
Bibliographical 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.Keywords
- Abdominal compartment syndrome
- Abdominal wall reconstruction
- Intestinal failure
- Intestinal fistula
- Laparostomy
- Negative pressure wound therapy
- Sepsis