Early Versus Delayed Source Control in Open Abdomen Management for Severe Intra‐abdominal Infections: A Retrospective Analysis on 111 Cases

• DOI: 10.1007/s00268-017-4233-y
• Publication Date: 2017-09-21T14:13:56Z
• Authors: Stefano Rausei; Vincenzo Pappalardo; Laura Ruspi; Antonio Colella; Simone Giudici; Vincenzo Ardita; Francesco Frattini; Francesca Rovera; Luigi Boni; Gianlorenzo Dionigi
• Keywords: Adult; Aged, 80 and over; Male; 2. Zero hunger; Adolescent; Critical Illness; Abdominal Wound Closure Techniques; Middle Aged; Fasciotomy; Time-to-Treatment; 3. Good health; Abdomen; Abdominal Wound Closure Techniques; Adolescent; Adult; Aged; Aged, 80 and over; Critical Illness; Fascia; Fasciotomy; Female; Hospital Mortality; Humans; Intraabdominal Infections; Male; Middle Aged; Retrospective Studies; Sepsis; Time-to-Treatment; Young Adult; Surgery; Young Adult; 03 medical and health sciences; 0302 clinical medicine; Sepsis; Abdomen; Humans; Intraabdominal Infections; Surgery; Female; Hospital Mortality; Fascia; Aged; Retrospective Studies

AbstractBackgroundTime to source control plays a determinant prognostic role in patients having severe intra‐abdominal infections (IAIs). Open abdomen (OA) management became an effective treatment option for peritonitis. Aim of this study was to analyze the correlation between time to source control and outcome in patients presenting with abdominal sepsis and treated by OA.MethodsWe retrospectively analyzed 111 patients affected by abdominal sepsis and treated with OA from May 2007 to May 2015. Patients were classified according to time interval from first patient evaluation to source control. The end points were intra‐hospital mortality and primary fascial closure rate.ResultsThe in‐hospital mortality rate was 21.6% (24/111), and the primary fascial closure rate was 90.9% (101/111). A time to source control ≥6 h resulted significantly associated with a poor prognosis and a lower fascial closure rate (mortality 27.0 vs 9.0%, p = 0.04; primary fascial closure 86 vs 100%, p = 0.02). We observed a direct increase in mortality (and a reduction in closure rate) for each 6‐h delay in surgery to source control.ConclusionEarly source control using OA management significantly improves outcome of patients with severe IAIs. This damage control approach well fits to the treatment of time‐related conditions, particularly in case of critically ill patients.