Open Abdomen in Nontrauma Patients: Fascial Closure and Favorable Discharge Outcomes
Shani Y Parnasa1, Nissim Sliman1, Alon J Pikarsky1
1Department of General Surgery, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
Introduction:
Open abdomen (OA) management is a critical intervention in patients with severe intra-abdominal conditions requiring damage-control surgery. Despite advances in care, OA is associated with high complication rates and mortality. This study aimed to identify prognostic factors associated with favorable outcomes in patients undergoing OA for nontraumatic indications.
Methods:
We conducted a single-center retrospective cohort study of patients undergoing emergency laparotomy with OA for nontraumatic indications between January 2017 and December 2023. Preoperative, perioperative, and postoperative data were collected and analyzed using univariate and multivariate regression models.
Results:
Among 124 patients (median age 66 y, 63.7% male), bowel ischemia was the leading indication for OA (61.3%). Overall, in-hospital mortality was 53.2%. Advanced age and high Sequential Organ Failure Assessment score were found as independent predictors of mortality (odds ratio 1.04, odds ratio 1.2, respectively. Abdominal closure was achieved in all surviving patients. Among 58 survivors, 5 developed enterocutaneous fistulas and 3 developed entero-atmospheric fistulas. Total parenteral nutrition and tracheostomy were associated with survival.
Conclusions:
Careful patient selection and advances in perioperative care contribute to high rates of fascial closure, a low incidence of fistulas, and favorable discharge outcomes, despite overall high mortality.
