AVAS Best Clinical Resident Award (Tied): Management and outcomes of the open abdomen in nontrauma patients

BackgroundLittle is known regarding the morbidity and mortality of the open abdomen technique in older nontrauma patients.MethodsA retrospective chart review identified cases of emergency laparotomy in which open abdomens were used.ResultsEighty-eight patients with open Acute Physiology and Chronic Health Evaluation (APACHE) abdomens were identified. An overall mortality rate of 34%, consistent with mortality predicted by APACHE IV score, was seen. Common complications included ventilator-associated pneumonia (30%) and acute renal failure (22%). A perioperative APACHE IV score of greater than 65 and an albumin level less than 2.5 g/dL were found to predict an increased likelihood of long-term assisted care placement after discharge from the acute care setting.ConclusionsThe use of the open abdomen technique in older nontrauma patients carries acceptable morbidity and mortality given the acuity of disease. Focus on ventilator-associated pneumonia prevention and aggressive fluid resuscitation to avoid acute renal failure may improve outcomes. Need for long-term assisted care placement can be predicted early after admission based on the APACHE IV score or albumin level.