Republication: Comparison of open abdomens in nontrauma and trauma patients: A retrospective study

• Published in: International journal of academic medicine 2016-08, Vol.2 (3), p.51-61
• Main Authors: Stawicki, Stanislaw, Cipolla, James, Bria, Corinne
• Format: Article
• Language: English
• ISSN: 2455-5568; 2455-5568
• DOI: 10.4103/2455-5568.188729

Introduction: Open abdomen (OA) spans an entire spectrum of traumatic and nontraumatic indications. We hypothesize that uniformly managed OA patients have favorable outcomes regardless of the initial traumatic or nontraumatic etiology. Materials and Methods: This is a retrospective review of OA patients from 2001 to 2006. A comparison was carried out between NTP and trauma OA patients, examining patient demographics, physiologic parameters, resource utilization, and outcome measures. Results: There were 60 OA patients (35 nontrauma patients [NTPs], 25 trauma patients [TPs]). NTPs were significantly older than TPs (60.9 vs. 38.3 years). The initial mean pH, Simplified Acute Physiology Score II (SAPS), and predicted and observed 28-day mortality were similar for both groups. The initial base deficit was 5.53 in NTP and 10.4 in TP (P = 0.0191). Lactic acid levels were 3.54 in NTP and 5.57 in TP (P = 0.0326). Time to abdominal closure was 18.2 days for TP and 20.7 days for NTP. NTP had longer mean Intensive Care Unit (ICU) stays (11.6 vs. 8.5 days, P= 0.0438). NTP had more abscesses (20.0% vs. 8.00%), fistulae (17.1% vs. 8.00%), and enteric leaks (11.4% vs. 4.00%) than TP. The average number of procedures per patient was 5.81 for NTP and 6.24 for TP (mean 4.34 days between procedures for NTP and 2.38 days for TP). Conclusions: TP and NTP undergoing OA showed many similarities. Outcomes for OA patients were similar regardless of the initial diagnosis. A trend was observed toward more postoperative complications in the NTP and greater initial physiologic derangement in TP. NTP had longer mean ICU stays. The mortality for both groups was half of that predicted by SAPS II score, likely due to the physiologic benefits of OA. The following core competencies are addressed in this article: Patient care; Medical knowledge; Practice based learning and improvement; Systems based practice. Republished with permission from: Stawicki SP, Cipolla J, Bria C. Comparison of open abdomens in nontrauma and trauma patients: A retrospective study. OPUS 12 Scientist. 2007;1(1):1-8.