IROA: International Register of Open Abdomen, preliminary results

Abstract

Background: No definitive data about open abdomen (OA) epidemiology and outcomes exist. The World Society of Emergency Surgery (WSES) and the Panamerican Trauma Society (PTS) promoted the International Register of Open Abdomen (IROA).

Methods: A prospective observational cohort study including patients with an OA treatment. Data were recorded on a web platform (Clinical Registers®) through a dedicated website: www.clinicalregisters.org.

Results: Four hundred two patients enrolled. Adult patients: 369 patients; Mean age: 57.39±18.37; 56% male; Mean BMI: 36±5.6. OA indication: Peritonitis (48.7%), Trauma (20.5%), Vascular Emergencies/Hemorrhage (9.4%), Ischemia (9.1%), Pancreatitis (4.2%),Post-operative abdominal-compartment-syndrome (3.9%), Others (4.2%). The most adopted Temporary-abdominal-closure systems were the commercial negative pressure ones (44.2%). During OA 38% of patients had complications; among them 10.5% had fistula. Definitive closure: 82.8%; Mortality during treatment: 17.2%. Mean duration of OA: 5.39(±4.83) days; Mean number of dressing changes: 0.88(±0.88). After-closure complications: (49.5%) and Mortality: (9%). No significant associations among TACT, indications, mortality, complications and fistula. A linear correlationexists between days of OA and complications (Pearson linear correlation = 0.326 p<0.0001) and with the fistula development (Pearson = 0.146 p= 0.016). Pediatric patients: 33 patients. Mean age: 5.91±(3.68) years; 60% male. Mortality: 3.4%; Complications: 44.8%; Fistula: 3.4%. Mean duration of OA: 3.22(±3.09) days.

Conclusion: Temporary abdominal closure is reliable and safe. The different techniques account for different results according to the different indications. In peritonitis commercial negative pressure temporary closure seems to improve results. In trauma skin-closure and Bogotà-bag seem to improve results.

Trial registration: ClinicalTrials.gov NCT02382770.

Keywords: Barker; Bogotà bag; Commercial; Compartment; IROA; Ischemia; Negative pressure; Non-commercial; Open abdomen; Peritonitis; Register; Skin; Trauma; Vascular emergencies; Witmann.

Figures

Fig. 1

IROA spread in the world

Fig. 2

Open abdomen treatment indications

Fig. 3

Overall negative event rate (NPWT: negative pressure wound therapy)

Fig. 4

Negative event rate in peritonitis (NPWT: negative pressure wound therapy)

Fig. 5

Negative event rate in trauma (NPWT: negative pressure wound therapy)

Fig. 6

Time distribution of overall complication

Fig. 7

Time distribution of fistula

Fig. 8

Definitive closure rate and days of open abdomen among different TAC techniques. Those patients died during treatment never achieved definitive closure and had a duration of treatment = infinite (as a consequence asymptotic curve indicates also survival). (TAC: temporary abdominal closure, NPWT: negative pressure wound therapy)

Fig. 9

Definitive closure rate and days of open abdomen among different TAC techniques in patients treated for peritonitis. Those patients died during treatment never achieved definitive closure and had a duration of treatment = infinite (as a consequence asymptotic curve indicates also survival). (TAC: temporary abdominal closure, NPWT: negative pressure wound therapy)

Fig. 10

Definitive closure rate and days of open abdomen among different TAC techniques in patients treated for trauma. Those patients died during treatment never achieved definitive closure and had a duration of treatment = infinite (as a consequence asymptotic curve indicates also survival). (TAC: temporary abdominal closure, NPWT: negative pressure wound therapy)