Feeding the open abdomen.
BACKGROUND
The purpose of this study was to determine if early enteral nutrition improves outcome for trauma patients with an open abdomen (OA).


METHODS
Retrospective review was used to identify 78 patients who required an OA for >or=4 hospital days, survived, and had available nutrition data. Demographic data and nutrition data comprising enteral nutrition initiation day and daily % target goal were collected. Patients were divided into 2 groups: early enteral feeding (EEN), initiated <or=4 days within celiotomy; and late enteral feeding (LEN; >4 days). Outcomes included infectious complications, early closure of the abdominal cavity (<8 days from original celiotomy), and fistula formation.


RESULTS
Fifty-three of 78 (68%) patients were men, with a mean age of 35 years; 74% had blunt trauma. Forty-three of 78 (55%) patients had EEN, whereas 35 of 78 (45%) had LEN. There was no difference with respect to demographics, injury severity, or infectious complication rates. Thirty-two of 43 (74%) patients with EEN had early closure of the abdominal cavity, whereas 17 of 35 (49%) patients with late feeding had early closure (p = .02). Four of 43 (9%) patients with EEN demonstrated fistula formation, whereas 9 of 35 (26%) patients with late feeding formed fistulae (p = .05). The EEN group had lower hospital charges (p = .04) by more than $50,000.


CONCLUSIONS
EEN in the OA was associated with (1) earlier primary abdominal closure, (2) lower fistula rate, (3) lower hospital charges.
Collier
Bryan
B
Division of Trauma and Surgical Critical Care, Vanderbilt University Medical Center, Nashville, Tennessee 37212, USA. bryan.collier@vanderbilt.edu
Guillamondegui
Oscar
O
Cotton
Bryan
B
Donahue
Rafe
R
Conrad
Andrew
A
Groh
Kate
K
Richman
Jill
J
Vogel
Todd
T
Miller
Richard
R
Diaz
Jose
J
D000007:Abdominal Injuries / Q000150:complications / Q000601:surgery / Q000628:therapy*; D000328:Adult; D001424:Bacterial Infections / Q000453:epidemiology; D003362:Cost-Benefit Analysis; D003422:Critical Care / Q000191:economics / Q000379:methods*; D004750:Enteral Nutrition / Q000191:economics / Q000379:methods*; D005260:Female; D005402:Fistula / Q000453:epidemiology; D017721:Hospital Costs; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome