A prediction model for fascial closure in the open abdomen

Objective/Introduction: The use of the open abdomen (OA) technique is an important approach for managing intra-abdominal catastrophes. However, delays in definitive fascial closure (DFC) are associated with a high incidence of complications and poor outcomes. The aim of this study is to develop a multivariate prediction model for DFC in patients being managed with an OA. Methods: A multicentre observational study was performed involving all patients managed with an OA admitted to Cairns, Townsville and Royal Brisbane & Women's Hospitals from 2000 to 2016. Prognostic factors were based on a recent systematic review. Statistical analysis was performed using multivariate logistic regression with 28 prognostic factors for DFC. Results: In total, 312 patients were managed with an OA. DFC occurred in 219 patients (70%). Median DFC time was 2 days (interquartile range: 3 days). Significant prognostic factors included Acute Physiology and Chronic Health Evaluation III score (odds ratio (OR): 0.97; 95% confidence interval (CI): 0.96, 0.98), respiratory failure (OR: 0.38; 95% CI: 0.16, 0.82), peritoneal contamination (OR: 0.22; 95% CI: 0.05, 0.98), total procedures (OR: 0.71; 95% CI: 0.63, 0.81) and year (OR: 1.1; 95% CI: 1.0, 1.2). A multivariate prediction model was developed to demonstrate a patient's likelihood of DFC (receiver operator curve area under curve = 0.88, 95% CI: 0.83, 0.92) Conclusion: Predictor variables were identified using clinical knowledge and statistical reasoning to develop a multivariate prediction model for DFC in patients being managed with an OA. External validation of this model will allow for this to be readily used in clinical practice.

N/A

SWAN 2018: Trauma, Critical Care & Emergency Surgery Conference

N/A

N/A

N/A

N/A

2