University of Oulu

Rasilainen, Suvi MD, PhD; Mentula, Panu MD, PhD; Salminen, Paulina MD, PhD; Koivukangas, Vesa MD, PhD; Hyöty, Marja MD, PhD; Mäntymäki, Leena-Mari MD; Pinta, Tarja MD, PhD; Haikonen, Jyrki MD; Rintala, Jukka MD, PhD; Rantanen, Tuomo MD, PhD; Strander, Tapani MB; Leppäniemi, Ari MD, PhD Superior primary fascial closure rate and lower mortality after open abdomen using negative pressure wound therapy with continuous fascial traction, Journal of Trauma and Acute Care Surgery: December 2020 - Volume 89 - Issue 6 - p 1136-1142 doi: 10.1097/TA.0000000000002889

Superior primary fascial closure rate and lower mortality after open abdomen using negative pressure wound therapy with continuous fascial traction

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Author: Rasilainen, Suvi1; Mentula, Panu1; Salminen, Paulina2;
Organizations: 1Department of Abdominal Surgery, Abdominal Center, Helsinki University Hospital and University of Helsinki, Helsinki
2Division of Di-gestive Surgery and Urology, Department of Surgery, Turku University Hospital, University of Turku, Turku, Department of Surgery, Satakunta Central Hospital, Pori
3Department of Abdominal Surgery, Oulu University Hospital, Oulu
4Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere
5Department of Surgery, Seinäjoki Central Hospital, Seinäjoki
6Department of Surgery, Satakunta Central Hospital, Pori
7Department of Surgery, Lapland Central Hospital, Rovaniemi
8Department of Surgery, Kuopio University Hospital, Institute of Clinical Medicine, University of Eastern Finland, Eastern Finland, Finland
Format: article
Version: accepted version
Access: open
Online Access: PDF Full Text (PDF, 0.3 MB)
Persistent link: http://urn.fi/urn:nbn:fi-fe2022031824129
Language: English
Published: Wolters Kluwer, 2020
Publish Date: 2022-03-18
Description:

Abstract

Background: Open abdomen (OA) is a useful option for treatment strategy in many acute abdominal catastrophes. A number of temporary abdominal closure (TAC) methods are used with limited number of comparative studies. The present study was done to examine risk factors for failed delayed primary fascial closure (DPFC) and risk factors for mortality in patients treated with OA.

Methods: This study was a multicenter retrospective analysis of the hospital records of all consecutive patients treated with OA during the years 2009 to 2016 at five tertiary referral hospitals and three secondary referral centers in Finland.

Results: Six hundred seventy-six patients treated with OA were included in the study. Vacuum-assisted closure with continuous mesh-mediated fascial traction (VACM) was the most popular TAC method used (N = 398, 59%) followed by VAC (N = 128, 19%), Bogota bag (N = 128, 19%), and self-designed methods (N = 22, 3%). In multivariate analysis, enteroatmospheric fistula and the number of needed TAC changes increased the risk for failed DPFC (odds ratio [OR], 8.9; 95% confidence interval [CI], 6.2–12.8; p < 0.001 and OR, 1.1; 95% CI, 1.0–1.3; p < 0.001, respectively). Instead, VACM and ruptured abdominal aortic aneurysm as cause for OA both decreased the risk for failed DPFC (OR, 0.1; 95% CI, 0.0–0.3; p < 0.001 and OR, 0.2; 95% CI, 0.1–0.7; p = 0.012). The overall mortality rate was 30%. In multivariate analysis for mortality, multiorgan dysfunction (OR, 2.4; 95% CI, 1.6–3.6; p < 0.001), and increasing age (OR, 4.5; 95% CI, 2.0–9.7; p < 0.001) predicted increased mortality. Institutional large annual patient volume (OR, 0.4; 95% CI, 0.3–0.6; p < 0.001) and ileus and postoperative peritonitis in comparison to severe acute pancreatitis associated with decreased mortality (OR, 0.2; 95% CI, 0.1–0.4; p < 0.001; OR, 0.5; 95% CI, 0.3–0.8; p = 0.009). Kaplan-Meier analysis showed increased survival in patients treated with VACM in comparison with other TAC methods (LogRank p = 0.019).

Conclusion: We report superior role for VACM methodology in terms of successful primary fascial closure and increased survival in patients with OA.

Level of evidence: Therapeutic/care management, level IV.

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Series: Journal of trauma and acute care surgery
ISSN: 2163-0755
ISSN-E: 2163-0763
ISSN-L: 2163-0755
Volume: 89
Issue: 6
Pages: 1136 - 1142
DOI: 10.1097/TA.0000000000002889
OADOI: https://oadoi.org/10.1097/TA.0000000000002889
Type of Publication: A1 Journal article – refereed
Field of Science: 3126 Surgery, anesthesiology, intensive care, radiology
Subjects:
Funding: This study was financially supported by a Helsinki University Hospital Research grant for emergency abdominal surgery.
Copyright information: © 2020 Wolters Kluwer Health, Inc. This manuscript version is made available under the CC-BY-NC 4.0 license by http://creativecommons.org/licenses/by-nc/4.0/.
  https://creativecommons.org/licenses/by-nc/4.0/