Clinical Scorecard: Factors Influencing Mortality in Open Abdomen Cases Due to Abdominal Sepsis: A Retrospective Analysis of 113 Patients
At a Glance
Category
Detail
Condition
Abdominal sepsis requiring open abdomen management
Key Mechanisms
Open abdomen indicated in septic shock, uncontrolled infection source, deferred intestinal anastomosis, visceral edema causing abdominal compartment syndrome
Target Population
Patients with abdominal sepsis including secondary/tertiary peritonitis, intestinal infarction, infected necrotizing pancreatitis, multiple abscesses
Care Setting
Academic surgical center managing severe abdominal sepsis with open abdomen and temporary abdominal closure techniques
Key Highlights
Open abdomen (OA) is increasingly used in abdominal sepsis with septic shock or severe contamination but carries high mortality risk.
Temporary abdominal closure (TAC) techniques include Negative Pressure Wound Therapy (NPWT), Vacuum-pack, and Skin-closure methods.
Definitive fascial closure success depends on infection control, clinical improvement, and organ vitality; mortality predictors remain under investigation.
Guideline-Based Recommendations
Diagnosis
Diagnose septic shock according to 3rd International Consensus Definitions for Sepsis and Septic Shock.
Identify abdominal sepsis causes such as generalized peritonitis, intestinal infarction, infected necrotizing pancreatitis, or multiple abscesses.
Management
Indicate OA in septic shock, inability to control infection source, deferred intestinal anastomosis, or abdominal compartment syndrome.
Choose TAC technique based on patient condition and surgical history; mesh-mediated NPWT recommended from second revision or index laparotomy in complex cases.
Decide on definitive fascial closure at second look based on infection control, clinical improvement, and organ vitality.
Monitoring & Follow-up
Monitor clinical and prognostic scores including ASA, Charlson Age-Comorbidity Index, APACHE II, Mannheim Peritonitis Index, and Frailty Clinical Scale.
Assess modified Björck classification at second look to evaluate OA status.
Follow patients for at least 1 year post-discharge with outpatient visits or phone interviews.
Risks
High mortality risk associated with OA in abdominal sepsis due to patient frailty and complications.
Potential complications include entero-atmospheric fistulas, abdominal compartment syndrome, and failure to achieve definitive fascial closure.
Delayed or inappropriate OA indication may worsen outcomes.
Patient & Prescribing Data
113 patients with abdominal sepsis undergoing OA from 2010 to 2019 in a single academic center
OA used in 7.6% of severe abdominal sepsis cases; comorbidities present in 96.1%, with high ASA scores and prognostic indices indicating severe illness; TAC techniques tailored to patient condition; definitive closure dependent on clinical improvement.
Clinical Best Practices
Careful patient selection for OA based on septic shock presence, contamination grade, comorbidities, and clinical deterioration.
Use of mesh-mediated NPWT for temporary abdominal closure in complex or repeated surgeries.
Multidisciplinary evaluation at second look to decide on continuation of OA or definitive fascial closure.
Regular assessment of prognostic scores and clinical parameters to guide management and predict mortality risk.
Long-term follow-up to monitor outcomes and complications.
by Dario Tartaglia, Jacopo Nicolò Marin, Alice Maria Nicoli, Andrea De Palma, Martina Picchi, Serena Musetti, Camilla Cremonini, Stefano Salvadori, Federico Coccolini, Massimo Chiarugi
