Factors Influencing Mortality in Open Abdomen Cases Due to Abdominal Sepsis
Overview
This retrospective study analyzed 113 patients with abdominal sepsis treated with open abdomen (OA) to evaluate perioperative mortality, morbidity, and fascial closure rates. Key predictive factors for mortality were identified, providing insights for surgical decision-making in this high-risk population.
Background
Abdominal sepsis arises from conditions such as generalized peritonitis, intestinal infarction, and infected pancreatitis. Open abdomen (OA) is increasingly used in damage control surgery for septic shock or when primary closure is not feasible due to visceral edema or abdominal compartment syndrome. Despite its benefits, OA carries risks of serious complications and high mortality. Limited data exist on predictors of mortality in septic patients undergoing OA, prompting this study to identify factors influencing outcomes.
OA was performed in 7.6% of patients operated for severe abdominal sepsis over a 9-year period.
High prevalence of comorbidities (96.1%) with significant rates of hypertension, cancer, and cardiac disease.
Half of the patients had an ASA score of IV, indicating severe systemic disease.
Mean MPI and APACHE II scores reflected severe peritonitis and critical illness.
Temporary abdominal closure techniques included NPWT, vacuum-pack, and skin-closure, with mesh-mediated NPWT used in complex cases.
Definitive fascial closure was defined as complete closure of the incised fascia and was a key outcome measure.
Clinical Implications
The study highlights the importance of comprehensive preoperative assessment including comorbidity indices and severity scores to predict mortality risk in OA patients with abdominal sepsis. Selection of appropriate temporary abdominal closure techniques and timing of definitive closure should be individualized based on patient condition and infection control. Awareness of these factors can guide surgeons in optimizing management strategies to improve survival and reduce complications.
Conclusion
Open abdomen management in abdominal sepsis patients involves high-risk individuals with significant comorbidities and critical illness severity. Identifying predictive factors of mortality aids in patient selection and tailoring surgical approaches to improve outcomes.
References
Barker et al. 2000 -- Vacuum-pack technique for temporary abdominal closure
Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) 2016
Amended Björck classification of open abdomen 2016
by Dario Tartaglia, Jacopo Nicolò Marin, Alice Maria Nicoli, Andrea De Palma, Martina Picchi, Serena Musetti, Camilla Cremonini, Stefano Salvadori, Federico Coccolini, Massimo Chiarugi
Older age, male sex, underweight status, reduced activities of daily living, and mild consciousness disturbance were associated with postextubation pneumonia in elective surgical patients.
