Open abdomen with negative pressure device vs primary abdominal closure for the management of surgical abdominal sepsis: a retrospective review.

Abstract:

BACKGROUND:Open abdomen with temporary abdominal closure remains a controversial management strategy for surgical abdominal sepsis compared with primary abdominal closure (PAC) and on-demand laparotomy. The primary objective was to compare mortality between PAC and open abdomen with vacuum assisted closure (VAC). METHODS:Retrospective review of a tertiary center intensive care unit database (2006 to 2010) including suspected/diagnosed severe abdominal sepsis/septic shock requiring source control laparotomy. Groups were categorized according to closure method at index source control laparotomy. APACHE-IV was used as a measure of disease severity. RESULTS:Of 211 patients, 75 PAC and 136 VAC cases were included. Controlling for disease severity, adjusted odds ratio of mortality for VAC was .41 95% confidence interval (.21, .81; P = .01) compared with PAC. PAC and VAC APACHE-1V predicted mortality rate were both 45%. VAC mortality was lower than PAC (22.8% vs 38.6%; P = .012). CONCLUSIONS:Open abdomen with VAC is associated with significantly improved survival compared with PAC in abdominal sepsis requiring laparotomy.

journal_name

Am J Surg

authors

Bleszynski MS,Chan T,Buczkowski AK

doi

10.1016/j.amjsurg.2016.01.012

subject

Has Abstract

pub_date

2016-05-01 00:00:00

pages

926-32

issue

5

eissn

0002-9610

issn

1879-1883

pii

S0002-9610(16)30061-7

journal_volume

211

pub_type

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