Etiology Matters: A Systematic Review and Meta-Analysis of Incidence and Outcomes in Abdominal Compartment Syndrome

ObjectiveTo determine if abdominal compartment syndrome (ACS) is a homogenous clinical entity, or if incidence and outcomes after ACS differ by precipitating cause.Data SourcesMEDLINE, Cochrane Reviews, Science Direct, and relevant articles identified through citation matching from January 2018 to January 2026.Study SelectionAdult patients (≥18 years old) diagnosed with ACS. For the metaanalysis, outcomes were compared between those with ACS (experimental group) and those without ACS (controls).Data ExtractionThis study was conducted in accordance with PRISMA guidelines. Dual independent review was conducted to screen studies at the abstract, full text, then outcome extraction level. After completion, all data was validated by a senior reviewer to ensure alignment with criteria.Data SynthesisA total of 100 manuscripts met inclusion criteria for data extraction, 33 reporting mortality, 90 reporting incidence of ACS, and a total of 21 studies included for meta-analysis of mortality. Total incidence of ACS was 0.05% across 1,176,638 unique patients, ranging from 15.16% in patients with moderate/severe pancreatitis to 0.22% in trauma patients.The unadjusted association between ACS and mortality varied by pathology, ranging from no observed association in ECMO patients to a moderate association in trauma patients (odds ratio [OR] 3.15; 95% CI 2.24, 4.43) and large association in nontrauma patients (OR 8.60; 95% CI 4.60, 16.07).ConclusionsCurrent literature related to ACS suggests that despite a similar underlying pathophysiology, ACS is a unique entity varying by precipitating cause. Future research should identify if treatment algorithms should consider the underlying disease state when managing ACS.