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Ceresoli M, Salvetti F, Kluger Y, Braga M, Viganò J, Fugazzola P, Sartelli M, Ansaloni L, Catena F, Coccolini F. Open Abdomen in Obese Patients: Pay Attention! New Evidences from IROA, the International Register of Open Abdomen. World J Surg 2019; 44:53-62. [PMID: 31602518 DOI: 10.1007/s00268-019-05209-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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.
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Affiliation(s)
- Marco Ceresoli
- School of Medicine and Surgery, Milano-Bicocca University, Monza, Italy. .,General and Emergency Surgery Department, ASST Monza, Via Pergolesi 33, 20900, Monza, Italy.
| | - Francesco Salvetti
- General and Emergency Surgery Department, Papa Giovanni XXIII Hospital, Bergamo, Italy.,Internal Medicine and Medical Therapy Department, School of Medicine and Surgery, University of Pavia, Pavia, Italy
| | - Yoram Kluger
- Division of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Marco Braga
- School of Medicine and Surgery, Milano-Bicocca University, Monza, Italy.,General and Emergency Surgery Department, ASST Monza, Via Pergolesi 33, 20900, Monza, Italy
| | - Jacopo Viganò
- Internal Medicine and Medical Therapy Department, School of Medicine and Surgery, University of Pavia, Pavia, Italy.,General Surgery I, Surgery Department, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | - Paola Fugazzola
- General, Emergency and Trauma Surgery Department, Bufalini Hospital, Cesena, Italy
| | - Massimo Sartelli
- General and Emergency Surgery, Macerata Hospital, Macerata, Italy
| | - Luca Ansaloni
- General, Emergency and Trauma Surgery Department, Bufalini Hospital, Cesena, Italy
| | - Fausto Catena
- Emergency Surgery Department, Parma University Hospital, Parma, Italy
| | - Federico Coccolini
- General, Emergency and Trauma Surgery Department, Bufalini Hospital, Cesena, Italy
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Luttrell TC, Khashwj H, Ingalls N, Coates J. Challenges of Complex Open Abdominal Wound Management in Trauma: A Novel Use of Chitosan and Hyaluronic Acid as a 3-Dimensional Scaffold to Overcome Resilient Open Abdomen Infections. J Am Coll Clin Wound Spec 2017; 7:25-29. [PMID: 28053865 DOI: 10.1016/j.jccw.2016.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Case presentation of a novel method for the management of complex open abdomen technique. This Mmethod includes the combination of chitosan, hyaluronic acid and negative pressure wound therapy. Patient was initially managed with traditional operating room wash-outs and packing. Implementation of novel method achieved closure in 17 days with split-thickness-skin-graft.
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Affiliation(s)
| | - Hasan Khashwj
- TCL Consulting, 5500 N Hwy 1, Fort Collins, CO 80524, USA
| | - Nicole Ingalls
- TCL Consulting, 5500 N Hwy 1, Fort Collins, CO 80524, USA
| | - Jay Coates
- TCL Consulting, 5500 N Hwy 1, Fort Collins, CO 80524, USA
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