Patients with an Open Abdomen in Asian, American and European Continents: A Comparative Analysis from the International Register of Open Abdomen (IROA)

Maria Grazia Sibilla, Camilla Cremonini, Mattia Portinari, Paolo Carcoforo, Dario Tartaglia, Enrico Cicuttin, Serena Musetti, Silvia Strambi, Massimo Sartelli, Margherita Koleva Radica, Fausto Catena, Massimo Chiarugi, Federico Coccolini, IROA Study Group, Giulia Montori, Fracensco Salvetti, Ionut Negoi, Monica Zese, Savino Occhionorelli, Sergei Shlyapnikov, Michael Sugrue, Zaza Demetrashvili, Daniele Dondossola, Orestis Ioannidis, Giuseppe Novelli, Cristina Frattini, Mirco Nacoti, Desmond Khor, Kenji Inaba, Demetrios Demetriades, Torsten Kaussen, Asri Che Jusoh, Wagih Ghannam, Boris Sakakushev, Ohad Guetta, Agron Dogjani, Stefano Costa, Sandeep Singh, Dimitrios Damaskos, Arda Isik, Kuo-Ching Yuan, Francesco Trotta, Stefano Rausei, Aleix Martinez-Perez, Giovanni Bellanova, Vinicius Cordeiro Fonseca, Fernando Hernández, Athanasios Marinis, Wellington Fernandes, Martha Quiodettis, Miklosh Bala, Andras Vereczkei, Rafael Curado, Gustavo Pereira Fraga, Bruno M Pereira, Mahir Gachabayov, Guillermo Perez Chagerben, Miguel Leon Arellano, Sefa Ozyazici, Gianluca Costa, Tugan Tezcaner, Matteo Porta, Yousheng Li, Faruk Karateke, Dimitrios Manatakis, Federico Mariani, Federico Lora, Ivan Sahderov, Boyko Atanasov, Sergio Zegarra, Luca Fattori, Rao Ivatury, Jimmy Xiao, Offir Ben-Ishay, Andrey Zharikov, Vincent Dubuisson, Maria Grazia Sibilla, Camilla Cremonini, Mattia Portinari, Paolo Carcoforo, Dario Tartaglia, Enrico Cicuttin, Serena Musetti, Silvia Strambi, Massimo Sartelli, Margherita Koleva Radica, Fausto Catena, Massimo Chiarugi, Federico Coccolini, IROA Study Group, Giulia Montori, Fracensco Salvetti, Ionut Negoi, Monica Zese, Savino Occhionorelli, Sergei Shlyapnikov, Michael Sugrue, Zaza Demetrashvili, Daniele Dondossola, Orestis Ioannidis, Giuseppe Novelli, Cristina Frattini, Mirco Nacoti, Desmond Khor, Kenji Inaba, Demetrios Demetriades, Torsten Kaussen, Asri Che Jusoh, Wagih Ghannam, Boris Sakakushev, Ohad Guetta, Agron Dogjani, Stefano Costa, Sandeep Singh, Dimitrios Damaskos, Arda Isik, Kuo-Ching Yuan, Francesco Trotta, Stefano Rausei, Aleix Martinez-Perez, Giovanni Bellanova, Vinicius Cordeiro Fonseca, Fernando Hernández, Athanasios Marinis, Wellington Fernandes, Martha Quiodettis, Miklosh Bala, Andras Vereczkei, Rafael Curado, Gustavo Pereira Fraga, Bruno M Pereira, Mahir Gachabayov, Guillermo Perez Chagerben, Miguel Leon Arellano, Sefa Ozyazici, Gianluca Costa, Tugan Tezcaner, Matteo Porta, Yousheng Li, Faruk Karateke, Dimitrios Manatakis, Federico Mariani, Federico Lora, Ivan Sahderov, Boyko Atanasov, Sergio Zegarra, Luca Fattori, Rao Ivatury, Jimmy Xiao, Offir Ben-Ishay, Andrey Zharikov, Vincent Dubuisson

Abstract

Background: International register of open abdomen (IROA) enrolls patients from several centers in American, European, and Asiatic continent. The aim of our study is to compare the characteristics, management and clinical outcome of adult patients treated with OA in the three continents.

Material and methods: A prospective analysis of adult patients enrolled in the international register of open abdomen (IROA).

Trial registration: NCT02382770.

Results: 1183 patients were enrolled from American, European and Asiatic Continent. Median age was 63 years (IQR 49-74) and was higher in the European continent (65 years, p < 0.001); 57% were male. The main indication for OA was peritonitis (50.6%) followed by trauma (15.4%) and vascular emergency (13.5%) with differences among the continents (p < 0.001). Commercial NPWT was preferred in America and Europe (77.4% and 52.3% of cases) while Barker vacuum pack (48.2%) was the preferred temporary abdominal closure technique in Asia (p < 0.001). Definitive abdominal closure was achieved in 82.3% of cases in America (fascial closure in 90.2% of cases) and in 56.4% of cases in Asia (p < 0.001). Prosthesis were mostly used in Europe (17.3%, p < 0.001). The overall entero-atmospheric fistula rate 2.5%. Median open abdomen duration was 4 days (IQR 2-7). The overall intensive care unit and hospital length-of-stay were, respectively, 8 and 11 days (no differences between continents). The overall morbidity and mortality rates for America, Europe, and Asia were, respectively, 75.8%, 75.3%, 91.8% (p = 0.001) and 31.9%, 51.6%, 56.9% (p < 0.001).

Conclusion: There is no uniformity in OA management in the different continents. Heterogeneous adherence to international guidelines application is evident. Different temporary abdominal closure techniques in relation to indications led to different outcomes across the continents. Adherence to guidelines, combined with more consistent data, will ultimately allow to improving knowledge and outcome.

Conflict of interest statement

All authors declare to have no conflict of interest.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
Median age (years, IQR) across the continents (p < 0.001)
Fig. 2
Fig. 2
Distribution across American, European and Asian continent of Indications and Temporary Abdominal Closure Technique (TACT); ACS abdominal compartment syndrome; NPWT negative pressure wound therapy
Fig. 3
Fig. 3
Use of NPWT across the continents
Fig. 4
Fig. 4
Mortality data through the different continents

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