Delayed Closure of 61 Open Abdomen Patients Based on an Algorithm

Area of Science:

• Surgical Management
• Trauma Surgery
• Critical Care Medicine

Background:

• Open abdomen (OA) management requires hemodynamic resuscitation, source control, and delayed abdominal closure.
• Optimal timing and methods for delayed abdominal closure in OA patients remain unclear.
• Existing scoring systems lack comprehensive criteria for guiding closure decisions.

Purpose of the Study:

• To evaluate an algorithm designed to determine the optimal timing for delayed abdominal closure in OA patients.
• To assess the efficacy of the algorithm in guiding the selection of appropriate delayed closure methods.
• To introduce and validate a novel Open Abdominal Fascial Closure (OAFC) scoring system.

Main Methods:

• Retrospective chart review of 61 OA patients managed according to the developed algorithm.
• Patients were assigned to skin-only or fascial closure groups based on Björck and OAFC scores.
• The OAFC score incorporates Sequential Organ Failure Assessment (SOFA) score, age, and malignancy.
• Closure methods included skin flaps, skin grafts, ABRA system, or ABRA with biologic mesh.

Main Results:

• The algorithm facilitated delayed abdominal closure in 90.2% of patients.
• Overall hospital mortality was 11.4%.
• Fascial closure resulted in a low incidence of small hernias (12.5%).

Conclusions:

• The evaluated algorithm provides practical and valid guidance for OA management.
• The novel OAFC scoring system aids in decision-making for delayed abdominal closure timing and method selection.
• This approach improves outcomes in open abdomen patients, reducing hernia formation.