Marco Ceresoli1,2, Francesco Salvetti3,4, Yoram Kluger5, Marco Braga6,7, Jacopo Viganò4,8, Paola Fugazzola9, Massimo Sartelli10, Luca Ansaloni9, Fausto Catena11, Federico Coccolini9. 1. School of Medicine and Surgery, Milano-Bicocca University, Monza, Italy. marco.ceresoli@libero.it. 2. General and Emergency Surgery Department, ASST Monza, Via Pergolesi 33, 20900, Monza, Italy. marco.ceresoli@libero.it. 3. General and Emergency Surgery Department, Papa Giovanni XXIII Hospital, Bergamo, Italy. 4. Internal Medicine and Medical Therapy Department, School of Medicine and Surgery, University of Pavia, Pavia, Italy. 5. Division of General Surgery, Rambam Health Care Campus, Haifa, Israel. 6. School of Medicine and Surgery, Milano-Bicocca University, Monza, Italy. 7. General and Emergency Surgery Department, ASST Monza, Via Pergolesi 33, 20900, Monza, Italy. 8. General Surgery I, Surgery Department, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy. 9. General, Emergency and Trauma Surgery Department, Bufalini Hospital, Cesena, Italy. 10. General and Emergency Surgery, Macerata Hospital, Macerata, Italy. 11. Emergency Surgery Department, Parma University Hospital, Parma, Italy.
Abstract
BACKGROUND: Open abdomen is the cornerstone of damage control strategies in acute care and trauma surgery. The role of BMI has not been well investigated. The aim of the study was to assess the role of BMI in determining outcomes after open abdomen. METHODS: This is an analysis of patients recorded into the International Register of Open Abdomen; patients were classified in two groups according to BMI using a cutoff of 30 kg/m2. The primary outcome was in-hospital mortality; secondary outcomes were primary fascia closure rate, length of treatment, complication rate, entero-atmospheric fistula rate and length of ICU stay. RESULTS: A total of 591 patients were enrolled from 57 centers, and obese patients were 127 (21.5%). There was no difference in mortality between the two groups; complications developed during the open treatment were higher in obese patients (63.8% vs. 53.4%, p = 0.038) while post-closure complications rate was similar. Obese patients had a significantly longer duration of the open treatment (9.1 ± 11.5 days vs. 6.3 ± 7.5 days; p = 0,002) and lower primary fascia closure rate (75.5% vs. 89.5%; p < 0,001). No differences in fistula rate were found. There was a linear correlation between the duration of open abdomen and the BMI (Pearson's linear correlation coefficient = 0,201; p < 0,001). CONCLUSIONS: Open abdomen in obese patients seems to be safe as in non-obese patients with similar mortality; however, in obese patients the length of open abdomen is significantly higher with higher complication rate, longer ICU length of stay and lower primary fascia closure rate. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov, Identifier: NCT02382770.
BACKGROUND: Open abdomen is the cornerstone of damage control strategies in acute care and trauma surgery. The role of BMI has not been well investigated. The aim of the study was to assess the role of BMI in determining outcomes after open abdomen. METHODS: This is an analysis of patients recorded into the International Register of Open Abdomen; patients were classified in two groups according to BMI using a cutoff of 30 kg/m2. The primary outcome was in-hospital mortality; secondary outcomes were primary fascia closure rate, length of treatment, complication rate, entero-atmospheric fistula rate and length of ICU stay. RESULTS: A total of 591 patients were enrolled from 57 centers, and obesepatients were 127 (21.5%). There was no difference in mortality between the two groups; complications developed during the open treatment were higher in obesepatients (63.8% vs. 53.4%, p = 0.038) while post-closure complications rate was similar. Obesepatients had a significantly longer duration of the open treatment (9.1 ± 11.5 days vs. 6.3 ± 7.5 days; p = 0,002) and lower primary fascia closure rate (75.5% vs. 89.5%; p < 0,001). No differences in fistula rate were found. There was a linear correlation between the duration of open abdomen and the BMI (Pearson's linear correlation coefficient = 0,201; p < 0,001). CONCLUSIONS: Open abdomen in obesepatients seems to be safe as in non-obesepatients with similar mortality; however, in obesepatients the length of open abdomen is significantly higher with higher complication rate, longer ICU length of stay and lower primary fascia closure rate. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov, Identifier: NCT02382770.
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