Classification--important step to improve management of patients with an open abdomen.
This short report is a distillation of the proceedings from a consensus group meeting in January 2009. It outlines a proposed classification system for patients with an open abdomen (OA). The classification allows (1) a description of the patient's clinical course; (2) standardized clinical guidelines for improving OA management; and (3) improved reporting of OA status, which will facilitate comparisons between studies and heterogeneous patient populations. The following grading is suggested: grade 1A, clean OA without adherence between bowel and abdominal wall or fixity of the abdominal wall (lateralization); grade 1B, contaminated OA without adherence/fixity; grade 2A, clean OA developing adherence/fixity; grade 2B, contaminated OA developing adherence/fixity; grade 3, OA complicated by fistula formation; grade 4, frozen OA with adherent/fixed bowel, unable to close surgically, with or without fistula. We propose that this classification system will facilitate communication, clarify OA management, and potentially improve patient care.
Björck
Martin
M
Department of Vascular Surgery, Institution of Surgical Sciences, Uppsala University Hospital, Uppsala, SE-751 85, Sweden. martin@bjorck.pp.se
Bruhin
Andreas
A
Cheatham
Michael
M
Hinck
Daniel
D
Kaplan
Mark
M
Manca
Guiseppe
G
Wild
Thomas
T
Windsor
Alastair
A
D034861:Abdominal Wall / Q000601:surgery*; D019299:Decompression, Surgical / Q000009:adverse effects / Q000145:classification*; D017408:Guidelines as Topic; D006801:Humans; D013530:Surgical Wound Infection / Q000145:classification*; D000267:Tissue Adhesions / Q000145:classification