Delayed abdominal closure in the management of ruptured abdominal aortic aneurysm.
The objective of this study was to compare initial use of the open abdomen using the vacuum-pack technique followed by delayed abdominal closure with standard primary abdominal closure in the treatment of ruptured abdominal aortic aneurysm (rAAA) repair. A retrospective review identified 122 rAAA cases, which were divided into two management eras: era 1 (primarily closed) and era 2 (47% open abdomen).One hundred three patients were included in this review: 58 in era 1 and 45 in era 2. Evidence of one of three ischemia-reperfusion (IR) criteria, preoperative hypotension, estimated blood loss > or = 6 L, or intraoperative resuscitation with > or = 12 L, predicted mortality. These criteria were also used as surrogate clinical markers for abdominal compartment syndrome. The in-hospital mortality was higher in those with at least one IR criterion: 43% versus 10% (p = .0003). In those with at least one IR criterion, the initial 24-hour mortality was 21% for era 1 versus 0% for era 2 (p = .03), and the 30-day mortality was 40% for era 1 and 32% for era 2 (p = .77).Three IR criteria were identified and were associated with increased mortality. Patients with these risk factors who were treated with delayed abdominal closure had an improved acute survival rate and a trend for improved long-term survival.
Kimball
Edward J
EJ
University of Utah, Salt Lake City, 84132, USA. edward.kimball@hsc.utah.edu
Adams
Danielle M
DM
Kinikini
Daniel V
DV
Mone
Mary C
MC
Alder
Stephen C
SC
D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000401:mortality / Q000601:surgery*; D001019:Aortic Rupture / Q000401:mortality / Q000601:surgery*; D016063:Blood Loss, Surgical / Q000517:prevention & control; D003161:Compartment Syndromes / Q000209:etiology; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D006973:Hypertension / Q000209:etiology; D007022:Hypotension / Q000150:complications; D008297:Male; D054843:Negative-Pressure Wound Therapy / Q000009:adverse effects / Q000401:mortality; D015427:Reperfusion Injury / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D013536:Suture Techniques / Q000009:adverse effects / Q000401:mortality; D013997:Time Factors; D065227:Transfusion Reaction; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality