title: Open abdominal management after damage-control laparotomy for trauma: a prospective observational American Association for the Surgery of Trauma multicenter study.
abstract: BACKGROUND
  We conducted a prospective observational multi-institutional study to examine the natural history of the open abdomen (OA) after trauma and identify risk factors for failure to achieve definitive primary fascial closure (DPC) after OA use in trauma.
  
  
  METHODS
  Adults requiring OA for trauma were enrolled during a 2-year period. Demographics, presentation, and management variables were used to compare primary fascial closure and non-primary fascial closure patients, with logistic regression used to identify independent risk factors for failure to achieve primary fascial closure.
  
  
  RESULTS
  A total of 572 patients from 14 American College of Surgeons-verified Level I trauma centers were enrolled. The majority were male (79%), mean (SD) age 39 (17) years. Injury Severity Score (ISS) was 15 or greater in 85% of patients and 84% had an abdominal Abbreviated Injury Scale (AIS) score of 3 or greater. Overall mortality was 23%. Initial primary fascial closure with unaltered native fascia was achieved in 379 patients (66%). Patients surviving at least 48 hours were grouped into those achieving DPC and those who did not achieve DPC after OA use. After logistic regression, independent risk factors for failure to achieve DPC included the number of reexplorations required (adjusted odds ratio [AOR], 1.3; 95% confidence interval (CI), 1.2-1.6; p < 0.001) the development of intra-abdominal abscess/sepsis (AOR, 2.4; 95% CI, 1.2-4.8; p = 0.011) bloodstream infection (AOR, 2.6; 95% CI, 1.2-5.7; p = 0.017), acute renal failure (AOR, 2.3; 95% CI, 1.2-5.7; p = 0.007), enteric fistula (AOR, 6.4; 95% CI, 1.2-32.8; p = 0.010) and ISS of greater than 15 (AOR, 2.5; 95% CI, 1.1-5.9; p = 0.037).
  
  
  CONCLUSIONS
  Our study identifies independent risk factors associated with failure to achieve primary fascial closure during initial hospitalization after OA use for trauma. Additional study is required to validate appropriate algorithms that optimize the opportunity to achieve primary fascial closure and outcomes in this population.
  
  
  METHODS
  Prognostic study, level III.
authors.affiliation: R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, Maryland 21201, USA. jjd3c@yahoo.com
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Dubose
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Scalea
authors.forename: John B
authors.initials: JB
authors.lastname: Holcomb
authors.forename: Binod
authors.initials: B
authors.lastname: Shrestha
authors.forename: Obi
authors.initials: O
authors.lastname: Okoye
authors.forename: Kenji
authors.initials: K
authors.lastname: Inaba
authors.forename: Tiffany K
authors.initials: TK
authors.lastname: Bee
authors.forename: Timothy C
authors.initials: TC
authors.lastname: Fabian
authors.forename: James
authors.initials: J
authors.lastname: Whelan
authors.forename: Rao R
authors.initials: RR
authors.lastname: Ivatury
mesh_terms: D000007:Abdominal Injuries / Q000601:surgery*; D058107:Abdominal Wound Closure Techniques / Q000009:adverse effects; D000328:Adult; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D007813:Laparotomy; D008297:Male; D008875:Middle Aged; D012086:Reoperation