Treatments and other prognostic factors in the management of the open abdomen: a systematic review

Background: The open abdomen (OA) is an important approach for managing intraabdominal catastrophes and continues to be the standard of care. Despite this, challenges remain with it associated with a high incidence of complications and poor outcomes. The objective of this article is to perform a systematic review in accordance with PRISMA guidelines to identify prognostic factors in OA patients in regards to definitive fascial closure (DFC), mortality and intra-abdominal complications. Methods: An electronic database search was conducted involving Medline, Excerpta Medica, Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature and Clinicaltrials.gov. All studies that described prognostic factors in regards to the above outcomes in OA patients were eligible for inclusion. Data collected were synthesised by each outcome of interest and assessed for methodological quality. Results: Thirty-one studies were included in the final synthesis. Enteral nutrition, organ dysfunction, local and systemic infection, number of re-explorations, worsening ISS and the development of a fistula appeared to significantly delay DFC. Age and APACHE II score were predictors for in-hospital mortality. Failed DFC, large bowel resection and > 5-10 litres of intravenous fluids in < 48 hours were predictors of entero-atmospheric fistula. The source of infection (small bowel as opposed to colon) was a predictor for ventral hernia. Large bowel resection, > 5-10 and > 10 litres of intravenous fluids in < 48 hours were predictors of intra-abdominal abscess. Fascial closure on (or after) day 5 and having a bowel anastomosis were predictors for anastomotic leak. Overall methodological quality was of a moderate level. Limitations: Overall methodological quality, high number of retrospective studies, low reporting of prognostic factors and the multitude of factors potentially affecting patient outcome that were not analysed. Conclusions: Careful selection and management of OA patients will avoid prolonged treatment and facilitate early DFC. Future research should focus on the development of a prognostic model.

Journal of Trauma and Acute Care Surgery

Journal of Trauma and Acute Care Surgery

82

2163-0763

N/A

2

12