BACKGROUND: Little is known regarding the morbidity and mortality of the open abdomen technique in older nontrauma patients. METHODS: A retrospective chart review identified cases of emergency laparotomy in which open abdomens were used. RESULTS: Eighty-eight patients with open Acute Physiology and Chronic Health Evaluation (APACHE) abdomens were identified. An overall mortality rate of 34%, consistent with mortality predicted by APACHE IV score, was seen. Common complications included ventilator-associated pneumonia (30%) and acute renal failure (22%). A perioperative APACHE IV score of greater than 65 and an albumin level less than 2.5 g/dL were found to predict an increased likelihood of long-term assisted care placement after discharge from the acute care setting. CONCLUSIONS: The use of the open abdomen technique in older nontrauma patients carries acceptable morbidity and mortality given the acuity of disease. Focus on ventilator-associated pneumonia prevention and aggressive fluid resuscitation to avoid acute renal failure may improve outcomes. Need for long-term assisted care placement can be predicted early after admission based on the APACHE IV score or albumin level.
BACKGROUND: Little is known regarding the morbidity and mortality of the open abdomen technique in older nontrauma patients. METHODS: A retrospective chart review identified cases of emergency laparotomy in which open abdomens were used. RESULTS: Eighty-eight patients with open Acute Physiology and Chronic Health Evaluation (APACHE) abdomens were identified. An overall mortality rate of 34%, consistent with mortality predicted by APACHE IV score, was seen. Common complications included ventilator-associated pneumonia (30%) and acute renal failure (22%). A perioperative APACHE IV score of greater than 65 and an albumin level less than 2.5 g/dL were found to predict an increased likelihood of long-term assisted care placement after discharge from the acute care setting. CONCLUSIONS: The use of the open abdomen technique in older nontrauma patients carries acceptable morbidity and mortality given the acuity of disease. Focus on ventilator-associated pneumonia prevention and aggressive fluid resuscitation to avoid acute renal failure may improve outcomes. Need for long-term assisted care placement can be predicted early after admission based on the APACHE IV score or albumin level.
Authors: A Willms; S Schaaf; R Schwab; I Richardsen; C Jänig; D Bieler; B Wagner; C Güsgen Journal: Langenbecks Arch Surg Date: 2017-04-05 Impact factor: 3.445
Authors: U A Dietz; C Wichelmann; C Wunder; J Kauczok; L Spor; A Strauß; R Wildenauer; C Jurowich; C T Germer Journal: Hernia Date: 2012-05-23 Impact factor: 4.739