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Nontrauma open abdomens: A prospective observational study.

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Emergency general surgery with an open abdomen (OA) is associated with prolonged hospital stays and high mortality, especially in older patients. Survivors often require significant post-discharge care, highlighting the critical condition of these patients.

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Area of Science:

  • Emergency general surgery
  • Surgical critical care
  • Abdominal surgery

Background:

  • Damage-control surgery with an open abdomen (OA) is established for trauma but understudied in emergency general surgery.
  • Limited data exists on OA use in emergency general surgery, necessitating a clearer understanding of patient demographics, indications, and outcomes.

Purpose of the Study:

  • To define demographics, indications for surgery and OA, complications, and mortality in emergency general surgery patients managed with an OA.
  • To investigate the association between age and mortality in this patient cohort.
  • To assess the need for specialized post-discharge care.

Main Methods:

  • A prospective observational study of 96 emergency general surgery patients managed with an OA from June 2013 to June 2014.
  • Data collected included demographics, comorbidities, operative variables, indications for OA, and complications.
  • Patients were stratified by age, and 6-month/1-year mortality was determined via the Social Security Death Index.

Main Results:

  • The median age was 61 years, with a median hospital stay of 25 days.
  • Common indications for OA included damage control (37%), perforated viscus/free air (20%), mesenteric ischemia (17%), and peritonitis (16%).
  • In-hospital mortality was 30%, with a 6-month mortality of 36%. Older patients had higher mortality rates, and 70% of survivors required post-discharge care.

Conclusions:

  • Emergency general surgery with OA involves a critically ill population with varied indications and high mortality.
  • Older age is a significant risk factor for mortality.
  • The substantial need for post-discharge care underscores the severity of illness and warrants further investigation.