Optimal tentative abdominal closure for open abdomen: a multicenter retrospective observational study (OPTITAC study)

Area of Science:

• Abdominal Surgery
• Wound Management
• Critical Care Medicine

Background:

• Primary fascia closure is challenging after open abdomen (OA) procedures.
• Negative-pressure wound therapy (NPWT) aids closure, but optimal parameters are unknown.
• This study investigates NPWT methods and pressures for OA tentative closure.

Purpose of the Study:

• To determine optimal negative-pressure wound therapy (NPWT) methods for open abdomen (OA) tentative closure.
• To identify ideal negative pressure levels for achieving primary fascia closure in OA patients.
• To assess the impact of NPWT on enteroatmospheric fistula incidence.

Main Methods:

• Multicenter retrospective cohort study (2010-2022) of adult OA survivors (>48h).
• Analysis of primary fascia closure rates and fistula incidence based on NPWT method (homemade, superficial kit, OA kit) and pressure (<50, 50-100, >100 mmHg).
• Generalized estimating equation used for statistical adjustment.

Main Results:

• High negative pressure (>100 mmHg) significantly reduced primary fascia closure rates (OR 0.18) and increased fistula risk (OR 13.83).
• NPWT methods did not impact closure success, but the open-abdomen kit lowered fistula incidence (OR 0.02).
• 252 out of 279 patients achieved primary fascia closure.

Conclusions:

• Avoid high negative pressure (>100 mmHg) in NPWT for open abdomen tentative closure.
• Utilizing an open-abdomen kit may reduce enteroatmospheric fistula formation.
• Further research into optimal NPWT strategies for OA is warranted.