Collins Reagan, Dhanasekara Chathurika Samudani, Morris Erin, Marschke Brianna, Dissanaike Sharmila
Department of Surgery, Texas Tech University Health Sciences Center, Lubbock, Texas, USA.
Trauma Surg Acute Care Open. 2022 Oct 21;7(1):e000980. doi: 10.1136/tsaco-2022-000980. eCollection 2022.
Multiple temporary abdominal closure (TAC) techniques are currently used to manage the open abdomen (OA) in severely injured trauma patients, with variability in efficacy and cost. We evaluated the clinical outcomes of two commonly used TAC methods: ABTHERA Negative Pressure Therapy System and whipstitch suture closure (WC).
We conducted a retrospective review of patients who had blunt or penetrating trauma from 2015 to 2021 with OA managed using either ABTHERA, WC, or both. Primary outcomes included overall and intensive care unit length of stay, ventilator days, number of laparotomies, time to definitive fascial closure, and complications (bleeding, evisceration, wound dehiscence, and reoperation). Univariate and multivariate analyses were used to compare baseline characteristics, outcomes, and complications. Potential mediators of the relationship between the type of TAC and outcomes were explored using mediation analyses.
A total of 112 TAC were analyzed; 86 patients had a single type of TAC placement (either WC or ABTHERA), whereas 26 had both types. A majority of patients had blunt trauma in both WC (77%) and ABTHERA (76%) cohorts. There were no differences in baseline characteristics, including injury severity (27.5±12.4 and 27.5±12.0 for ABTHERA and WC, respectively). There was no statistically significant difference among individual complications and overall complications (OR=0.622 (0.274 to 1.412)). No differences were found between the outcomes, and any apparent differences seen were mediated by factors such as a higher number of laparotomies.
WC is a low-cost option for TAC in trauma, with similar clinical outcomes and complications to ABTHERA.
Level III therapeutic/care management study.
目前多种临时腹部关闭（TAC）技术用于管理严重创伤患者的开放性腹部（OA），疗效和成本存在差异。我们评估了两种常用TAC方法的临床结果：ABTHERA负压治疗系统和连续缝合法关闭（WC）。
我们对2015年至2021年因钝性或穿透性创伤导致OA并采用ABTHERA、WC或两者进行治疗的患者进行了回顾性研究。主要结局包括总住院时间和重症监护病房住院时间、呼吸机使用天数、剖腹手术次数、确定性筋膜关闭时间以及并发症（出血、脏器脱出、伤口裂开和再次手术）。采用单因素和多因素分析比较基线特征、结局和并发症。使用中介分析探讨TAC类型与结局之间关系的潜在中介因素。
共分析了112例TAC病例；86例患者仅采用一种TAC方法（WC或ABTHERA），而26例患者同时采用了两种方法。在WC组（77%）和ABTHERA组（76%）中，大多数患者为钝性创伤。基线特征无差异，包括损伤严重程度（ABTHERA组和WC组分别为27.5±12.4和27.5±12.0）。个体并发症和总体并发症之间无统计学显著差异（OR=0.622（0.274至1.412））。结局之间未发现差异，任何明显差异均由剖腹手术次数较多等因素介导。
WC是创伤患者TAC的低成本选择，临床结局和并发症与ABTHERA相似。
III级治疗/护理管理研究。
