Comparison of open abdomens in non-trauma and trauma patients: A retrospective study
S. Peter Stawicki, James Cipolla, Corinne Bria
Abstract
Introduction: Open abdomen (OA) spans an entire spectrum of traumatic and non-traumatic indications. We hypothesize that uniformly managed OA patients have favorable outcomes regardless of the initial traumatic or non-traumatic etiology.
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 non-trauma (NTP), 25 trauma (TP)]. NTP were significantly older than TP (60.9 vs 38.3 years). The initial mean pH, SAPS II score, 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 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.
Copyright 2007 OPUS 12 Foundation, Inc.
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 non-trauma (NTP), 25 trauma (TP)]. NTP were significantly older than TP (60.9 vs 38.3 years). The initial mean pH, SAPS II score, 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 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.
Copyright 2007 OPUS 12 Foundation, Inc.
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