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

Am J Surg. 2009 Nov;198(5):588-92. doi: 10.1016/j.amjsurg.2009.07.023.


Background: Little is known regarding the morbidity and mortality of the open abdomen technique in older nontrauma patients.

Methods: A retrospective chart review identified cases of emergency laparotomy in which open abdomens were used.

Results: Eighty-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.

Conclusions: The 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.

MeSH terms

  • Comorbidity
  • Digestive System Diseases / epidemiology
  • Digestive System Diseases / surgery*
  • Digestive System Surgical Procedures / methods
  • Digestive System Surgical Procedures / mortality
  • Female
  • Fluid Therapy
  • Humans
  • Laparotomy
  • Length of Stay
  • Male
  • Middle Aged
  • Pneumonia, Ventilator-Associated / epidemiology
  • Pneumonia, Ventilator-Associated / prevention & control
  • Postoperative Complications / epidemiology
  • Retrospective Studies
  • Surgical Mesh