Current Therapy and Short-Term Results of Open Abdominal Management Among Non-trauma Patients

Introduction Damage control surgery (DCS) with open abdominal management (OAM) has been established for the treatment of trauma patients; however, in recent years, it has been increasingly expanded to include the management of non-trauma patients with severe conditions. Since 2020, we have performed OAM combined with negative pressure wound therapy (NPWT) for critically ill non-trauma patients. Methods We retrospectively reviewed 43 patients who underwent OAM between April 2020 and March 2024. The primary outcome was in-hospital mortality, and the secondary outcomes were postoperative complications, primary fascial closure rate, and duration of OAM. Analyses of postoperative complications, duration of OAM, and primary fascial closure were restricted to patients who survived beyond 24 hours, because these outcomes could not be meaningfully assessed in patients who died shortly after the initial surgery. Results Forty-three patients (67% were men) were included in the primary outcome. The median (interquartile range) age was 71 (59-80) years, and the median Charlson Comorbidity Index was 5 (range, 4-7). Indications for OAM included bowel perforation (52%), peritonitis due to strangulated bowel obstruction (16%), postoperative anastomotic leakage (12%), intra-abdominal hemorrhage (9%), non-occlusive mesenteric ischemia (9%), and superior mesenteric artery thrombosis (2%). The mortality rate was 18.6%. Three patients who died within 24 hours were excluded from the secondary outcome analyses, leaving 40 patients for evaluation. The complication rate was 58%, and 23% of cases were classified as Clavien-Dindo grade ≥III. Intra-abdominal complications occurred, including anastomotic leakage, intra-abdominal abscess, and intestinal ischemia. Moreover, pulmonary and vascular complications (e.g., pneumonia, cerebral infarction, and ischemic heart disease) were observed. Primary fascial closure was achieved in all 40 patients included in the secondary outcome analysis (100%). Conclusion OAM with NPWT for non-trauma patients may be considered an option for patients with severe general conditions or when intra-abdominal reevaluation is necessary. Further studies are required to improve mortality and complication rates.