Poillucci Gaetano, Podda Mauro, Russo Giulia, Perri Sergio Gaetano, Ipri Domenico, Manetti Gabriele, Lolli Maria Giulia, De Angelis Renato
Department of General and Specialized Surgery "Paride Stefanini", Policlinico Universitario Umberto I, Viale del Policlinico, 155, 00161, Rome, Italy.
Department of General, Emergency and Minimally Invasive Surgery, Policlinico Universitario "D. Casula", University of Cagliari, Monserrato, Italy.
Eur J Trauma Emerg Surg. 2021 Dec;47(6):1819-1825. doi: 10.1007/s00068-020-01379-0. Epub 2020 May 6.
The open abdomen (OA) procedure as part of damage control surgery represents a significant surgical advance in severe intra-abdominal infections. Major techniques used for OA are negative pressure wound therapy (NPWT) and non-NPWT. The aim of this retrospective study is to evaluate the effects of different abdominal closure methods and their outcomes in patients presenting with abdominal sepsis treated with OA.
We retrospectively analyzed clinical outcomes of patients affected by severe intra-abdominal sepsis treated with OA. Demographic features, mortality prediction score, abdominal closure methods, length of hospital stay, complications and mortality rates of patients were determined and compared.
This study included 106 patients, of whom 77 underwent OA with NPWT and 29 with non-NPWT. OA duration was longer in NPWT patients (p = 0.007). In-hospital mortality rates in NPWT and in non-NPWT patients were 40.3% and 51.7%, respectively (p = 0.126), with an overall 30-day mortality rate of 18.2% and 51.7%, respectively (p = 0.0002). After emergency colorectal surgery, patients who underwent OA with NPWT had a lower rate of colostomy (p = 0.025).
NPWT is the best temporary abdominal closure technique to decrease mortality and colostomy rates in patients managed with OA for severe intra-abdominal infections.
作为损伤控制手术一部分的开放腹腔（OA）手术是严重腹腔内感染治疗中的一项重大外科进展。用于OA的主要技术是负压伤口治疗（NPWT）和非NPWT。本回顾性研究的目的是评估不同腹部闭合方法对接受OA治疗的腹部脓毒症患者的效果及其结局。
我们回顾性分析了接受OA治疗的严重腹腔内脓毒症患者的临床结局。确定并比较了患者的人口统计学特征、死亡率预测评分、腹部闭合方法、住院时间、并发症及死亡率。
本研究纳入106例患者，其中77例接受NPWT的OA治疗，29例接受非NPWT的OA治疗。NPWT患者的OA持续时间更长（p = 0.007）。NPWT患者和非NPWT患者的院内死亡率分别为40.3%和51.7%（p = 0.126），30天总死亡率分别为18.2%和51.7%（p = 0.0002）。急诊结直肠手术后，接受NPWT的OA治疗的患者结肠造口率较低（p = 0.025）。
对于接受OA治疗的严重腹腔内感染患者，NPWT是降低死亡率和结肠造口率的最佳临时腹部闭合技术。
