MANAGEMENT OF THE OPEN ABDOMEN IN NON-TRAUMATIC PATIENTS- ACHIEVING HIGH FASCIAL CLOSURE RATES AND FAVORABLE DISCHARGE OUTCOMES rbalam@hadassah.org.il

 

MANAGEMENT OF THE OPEN ABDOMEN IN NON-TRAUMATIC PATIENTS- ACHIEVING HIGH FASCIAL CLOSURE RATES AND FAVORABLE DISCHARGE OUTCOMES

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Israel

Oral only

Open abdomen (OA) management is a critical intervention for patients with severe intra-abdominal conditions in damage control settings. However, OA is frequently associated with high complication rates and poor outcomes. This study aimed to identify prognostic factors associated with favorable outcomes in patients undergoing OA for non-traumatic indications.

This single-center retrospective cohort study reviewed patients who underwent emergency laparotomy with OA for non-traumatic indications between January 2017 and December 2023. Preoperative and perioperative clinical data were collected, and outcomes were analyzed using univariate and multivariate regression models.

A total of 124 patients were included, with a median age of 66 years; 79 (63.7%) were male. The leading indication for OA was bowel ischemia (76 patients, 61.3%). The overall in-hospital mortality rate was 53.2% (66 patients). Higher mortality correlated significantly with older age (p<0.001), ischemic heart disease (p=0.018), arrhythmia (p=0.016), chronic kidney disease (p=0.006), dialysis (p<0.001), anticoagulation therapy (p=0.03), and elevated Sequential Organ Failure Assessment (SOFA) scores (p=0.003). Among survivors, 58.6% were discharged home. Among patients who were discharged, primary abdominal closure was achieved in 86.2%. Platelet transfusion during the index surgery was independently associated with an increase in hospital mortality (OR 7.0).

Despite the overall high mortality risk, careful patient selection and advances in perioperative care have contributed to high rates of fascial closure, a low incidence of entero-cutaneous fistulas, and favorable discharge outcomes in this challenging population.