title: Outcomes and complications of open abdomen technique for managing non-trauma patients.
abstract: BACKGROUND
  Damage control surgery and the open abdomen technique have been widely used in trauma. These techniques are now being utilized more often in non-trauma patients but the outcomes are not clear. We hypothesized that the use of the open abdomen technique in non-trauma patients 1) is more often due to peritonitis, 2) has a lower incidence of definitive fascial closure during the index hospitalization, and 3) has a higher fistula rate.
  
  
  METHODS
  Retrospective case series of patients treated with the open abdomen technique over a 5-year period at a level-I trauma center. Data was collected from the trauma registry, operating room (OR) case log, and by chart review. The main outcome measures were number of operations, definitive fascial closure, fistula rate, complications, and length of stay.
  
  
  RESULTS
  One hundred and three patients were managed with an open abdomen over the 5-year period and we categorized them into three groups: elective (n = 31), urgent (n = 35), and trauma (n = 37). The majority of the patients were male (69%). Trauma patients were younger (39 vs 53 years; P < 0.05). The most common indications for the open abdomen technique were intraabdominal hypertension in the elective group (n = 18), severe intraabdominal infection in the urgent group (n = 19), and damage control surgery in the trauma group (n = 28). The number of abdominal operations was similar (3.1-3.7) in the three groups, as was the duration of intensive care unit (ICU) stay (average: 25-31 days). The definitive fascial closure rates during initial hospitalization were as follows: 63% in the elective group, 60% in the urgent group, and 54% in the trauma group. Intestinal fistula formation occurred in 16%, 17%, and 11%, respectively, in the three groups, with overall mortality rates of 35%, 31%, and 11%.
  
  
  CONCLUSIONS
  Intra-abdominal infection was a common reason for use of the open abdomen technique in non-trauma patients. However, the definitive fascial closure and fistula rates were similar in the three groups. Despite differences in indications, damage control surgery and the open abdomen technique have been successfully transitioned to elective and urgent non-trauma patients.
authors.affiliation: Department of Surgery, Section of Trauma/Critical Care Surgery, Stanford University School of Medicine, USA.
authors.forename: Kritaya
authors.initials: K
authors.lastname: Kritayakirana
authors.forename: Paul
authors.initials: P
authors.lastname: M Maggio
authors.forename: Susan
authors.initials: S
authors.lastname: Brundage
authors.forename: Mary-Anne
authors.initials: MA
authors.lastname: Purtill
authors.forename: Kristan
authors.initials: K
authors.lastname: Staudenmayer
authors.forename: David
authors.initials: D
authors.lastname: A Spain