Survey on the perception and management of the abdominal compartment syndrome among Belgian surgeons

Although first described decades ago, the abdominal compartment syndrome (ACS) has been recognized in recent years as a significant factor in organ failure and mortality in critically ill patients. Since the syndrome frequently occurs in surgical patients, mainly after abdominal surgery or trauma and the treatment of ACS, regardless of the cause, is essentially surgical, we conducted this survey to assess the perception of ACS in the Belgian surgical community.

A questionnaire was sent electronically to all E-mail addresses featured in the official website of the Royal Belgian Society for Surgery (www.belsurg.org) in October 2005 and a reminder was sent to the same addresses in December 2005. The questionnaire consisted of six general questions, designed to reflect the clinical practice and experience of the surgeon involved, and 15 ACS specific questions.

We received completed questionnaires from 41 surgeons. Most answers came from surgeons working in academic hospitals (72.5%) or large hospitals (mean number of beds 612), surgeons training residents (83%) and surgeons practicing abdominal surgery (mean percentage of abdominal surgery 75%). Eighty percent of surgeons claim to be familiar with ACS while only 41% have ever measured intra-abdominal pressure (mostly through intermittently measured bladder pressure). The surgeons who answered generally had a good knowledge of normal intra-abdominal pressures and criteria for ACS. Only 27.5% of surgeons routinely measure IAP. They associate ACS mostly with situations of abdominal trauma, intra-abdominal bleeding and abdominal sepsis. Seventy five percent of surgeons have performed at least one decompressive laparotomy and all claim they would consider doing so if indicated. Most cited indications were ventilation difficulty, oliguria, acidosis and decreased cardiac output. Sixty percent of surgeons have left the abdomen open at least once to prevent ACS.

The low response rate to this survey suggests that awareness of ACS in the general surgical community in Belgium is low. However, those who did respond are mostly surgeons from academic or other large hospitals and have a good basic knowledge of definitions, diagnosis and treatment of ACS.