MULTIDIMENSIONAL ANALYSIS OF PROGNOSTIC FACTORS OF OUTCOME IN EMERGENCY DAMAGE CONTROL SURGERY WITH OPEN ABDOMEN FOR INTRA-ABDOMINAL INFECTION pretef@gmail.com

PW05-04

MULTIDIMENSIONAL ANALYSIS OF PROGNOSTIC FACTORS OF OUTCOME IN EMERGENCY DAMAGE CONTROL SURGERY WITH OPEN ABDOMEN FOR INTRA-ABDOMINAL INFECTION

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Angela Gurrado angela.gurrado@gmail.com University of Bari Department of Precision and Regenerative Medicine and Jonian area (DiMePRe-J) Bari Italy

Mario Testini mario.testini@uniba.it University of Bari Department of Precision and Regenerative Medicine and Jonian area (DiMePRe-J) Bari Italy

 

 

Italy

Oral or Poster

Damage control surgery(DCS) has become the standard approach in emergency surgical patients when physiologic instability necessitates an abbreviated operation. In severe intraabdominal infections(IAI), open abdomen(OA) with Negative Pressure Wound Therapy(NPWT) has shown rates of fascial closure around 90%. Limited evidence is available on key outcomes, such as mortality and perioperative complications during OA, which are needed to select adequate therapeutic strategies

From 113 cases of DCS and OA with NPWT performed between February 2015 and February 2025, 77 consecutive patients treated for severe IAI were retrospectively reviewed. Overall 30-day survival and perioperative complication rates (primary outcomes) were correlated with procedure-related metrics and diagnostic and clinicopathological variables.

The main indication for OA was planned relook. Overall mortality was 26%. At univariable analysis, delayed source control (>24hrs,p=0.024)), ASA IV status(p<0.001), Mannheim Peritonitis Index>26 (p<0.001) and APACHE II score>24 (p<0.001) associated with increased mortality. APACHE II score was the only independent predictor of mortality(1.65, 95%CI 1.25-2.92,p=0.005). Sixty-six patients survived to achieve abdomen closure, and overall PFC rate was 92.4%(61 patients). In surviving patients with OA lasting >7 days, nine(56.3%, p<0.001) experienced complications including enteroatmospheric fistula(EAF,18.8%) and frozen abdomen(43.8%).

Severity of illness captured by APACHE II was independent factor for survival in patients undergoing DCS for severe IAI. Although very resource-intensive, DCS and OA are valuable tools to manage patients with advanced abdominal sepsis, allowing reduced mortality and high DFC rates. Duration of the OA did not impact on survival, though late abdomen closure may significantly associate with EAF and frozen abdomen.