Spill your guts! Perceptions of Trauma Association of Canada member surgeons regarding the open abdomen and the abdominal compartment syndrome.
BACKGROUND
To survey surgeon opinion regarding the management of the open abdomen (OA) and abdominal compartment syndrome (ACS) to assess current practice and direct future prospective clinical studies.


METHODS
Opinions of self-designated trauma, general, pediatric, and vascular surgeons belonging to the Trauma Association of Canada (TAC), were surveyed through a mixed-mode (mail and Web based) questionnaire.


RESULTS
Among 102 eligible candidates, 86 (84%) responded; 83% did regular trauma call, 45% regular critical care call being a separate call 79% of the time; 79% worked in centers serving >500,000 people; the median year of practice entry was 1997. There was no standard definition of what constituted an "open abdomen", preferred time for re-operation, or preferred method for alternate fascial closure, although 90% reported having not closing the fascia after a trauma laparotomy. Being "physically unable" was reported as an indication twice as often as objective measures of airway or bladder pressures. The decision to proceed with OA was reported as rarely or never being made preoperatively by 78% of respondents. None reported an institutional policy regarding OA. Eighty-four percent reported (re)opening an abdomen for primary ACS, 46% for secondary ACS, 28% for tertiary ACS. Self-assessed familiarity for the ACS was 6/7 on a Likert scale. Physical examination was reported as a diagnostic criterion for ACS by 66%, and used to screen by 21% of respondents.


CONCLUSIONS
There is no consensus regarding definition, functional indications, or management of an open abdomen in the perceptions of Canadian trauma providers despite a high self reported level of familiarity with the abdominal compartment syndrome. This is an area of practice with potential and requirements for further multi-center study.
Kirkpatrick
Andrew W
AW
Department of Medicine, Foothills Medical Centre, Calgary, Alberta, Canada. andrew.kirkpatrick@calgaryhealthregion.ca
Laupland
Kevin B
KB
Karmali
Shahzeer
S
Bergeron
Eric
E
Stewart
T Charyk
TC
Findlay
Christie
C
Parry
N
N
Khetarpal
Suneel
S
Evans
D
D
D000005:Abdomen / Q000601:surgery*; D001291:Attitude of Health Personnel; D002170:Canada; D002983:Clinical Competence / Q000592:standards; D003161:Compartment Syndromes / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control; D003657:Decision Making; D000071938:Fasciotomy; D005544:Forecasting; D006301:Health Services Needs and Demand; D006801:Humans; D007813:Laparotomy / Q000009:adverse effects / Q000193:education / Q000379:methods* / Q000706:statistics & numerical data; D008403:Mass Screening; D018579:Patient Selection; D010808:Physical Examination; D010820:Physicians / Q000458:organization & administration / Q000523:psychology*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D012008:Recurrence; D012086:Reoperation; D020377:Self Efficacy; D012955:Societies, Medical; D013526:Surgical Mesh; D011795:Surveys and Questionnaires; D013536:Suture Techniques; D013997:Time Factors; D014194:Traumatology / Q000193:education / Q000379:methods* / Q000706:statistics & numerical data