Feeding the open abdomen

JPEN J Parenter Enteral Nutr. Sep-Oct 2007;31(5):410-5. doi: 10.1177/0148607107031005410.

Abstract

Background: The purpose of this study was to determine if early enteral nutrition improves outcome for trauma patients with an open abdomen (OA).

Methods: Retrospective review was used to identify 78 patients who required an OA for >or=4 hospital days, survived, and had available nutrition data. Demographic data and nutrition data comprising enteral nutrition initiation day and daily % target goal were collected. Patients were divided into 2 groups: early enteral feeding (EEN), initiated <or=4 days within celiotomy; and late enteral feeding (LEN; >4 days). Outcomes included infectious complications, early closure of the abdominal cavity (<8 days from original celiotomy), and fistula formation.

Results: Fifty-three of 78 (68%) patients were men, with a mean age of 35 years; 74% had blunt trauma. Forty-three of 78 (55%) patients had EEN, whereas 35 of 78 (45%) had LEN. There was no difference with respect to demographics, injury severity, or infectious complication rates. Thirty-two of 43 (74%) patients with EEN had early closure of the abdominal cavity, whereas 17 of 35 (49%) patients with late feeding had early closure (p = .02). Four of 43 (9%) patients with EEN demonstrated fistula formation, whereas 9 of 35 (26%) patients with late feeding formed fistulae (p = .05). The EEN group had lower hospital charges (p = .04) by more than $50,000.

Conclusions: EEN in the OA was associated with (1) earlier primary abdominal closure, (2) lower fistula rate, (3) lower hospital charges.

MeSH terms

  • Abdominal Injuries / complications
  • Abdominal Injuries / surgery
  • Abdominal Injuries / therapy*
  • Adult
  • Bacterial Infections / epidemiology
  • Cost-Benefit Analysis
  • Critical Care / economics
  • Critical Care / methods*
  • Enteral Nutrition / economics
  • Enteral Nutrition / methods*
  • Female
  • Fistula / epidemiology
  • Hospital Costs*
  • Humans
  • Injury Severity Score
  • Male
  • Postoperative Complications / epidemiology*
  • Retrospective Studies
  • Risk Factors
  • Survival Rate
  • Time Factors
  • Treatment Outcome