AVAS Best Clinical Resident Award (Tied): Management and outcomes of the open abdomen in nontrauma patients
Received 5 May 2009; received in revised form 15 July 2009
Abstract
Background
Little is known regarding the morbidity and mortality of the open abdomen technique in older nontrauma patients.
Methods
A retrospective chart review identified cases of emergency laparotomy in which open abdomens were used.
Results
Eighty-eight patients with open Acute Physiology and Chronic Health Evaluation (APACHE) abdomens were identified. An overall mortality rate of 34%, consistent with mortality predicted by APACHE IV score, was seen. Common complications included ventilator-associated pneumonia (30%) and acute renal failure (22%). A perioperative APACHE IV score of greater than 65 and an albumin level less than 2.5 g/dL were found to predict an increased likelihood of long-term assisted care placement after discharge from the acute care setting.
Conclusions
The use of the open abdomen technique in older nontrauma patients carries acceptable morbidity and mortality given the acuity of disease. Focus on ventilator-associated pneumonia prevention and aggressive fluid resuscitation to avoid acute renal failure may improve outcomes. Need for long-term assisted care placement can be predicted early after admission based on the APACHE IV score or albumin level.
Michael E DeBakey Department of Surgery, Baylor College of Medicine, Michael E. DeBakey VA Medical Center, 2002 Holcombe Blvd., Operative Care Line (112), Houston, TX 77030, USA
ABSTRACT