title: Outcome of negative-pressure wound therapy for open abdomen treatment after nontraumatic lower gastrointestinal surgery: analysis of factors affecting delayed fascial closure in 101 patients.
abstract: BACKGROUND
  Few studies have focused on the risk factors for failure to achieve fascial closure after use of negative-pressure wound therapy (NPWT) in an open abdomen (OA). We aimed at analyzing possible risk factors for failure of fascial closure and the risk of fistulas after nontrauma lower gastrointestinal (GI) tract surgery treated with OA.
  
  
  METHODS
  This retrospective study included 101 nontrauma patients treated with OA from 2007 to 2011. Multivariate analyses of risk factors were performed.
  
  
  RESULTS
  Indications for OA were diffuse peritonitis (n = 47), need for second look (n = 26), failure to achieve fascial closure (e.g., bowel edema) at primary laparotomy (n = 24), and fascial necrosis (n = 4). Of the 101 patients, 61 (60 %) were alive at discharge, with one death possibly related to OA (fistula from an iatrogenic perforation). Delayed fascial closure was obtained in 40 (66 %) of the surviving patients, with 80 % when the indications for OA was need for second look and 72 % in cases of diffuse peritonitis. Compared with need for second look [hazard ratio (HR = 1), 95 % CI], proportional HR for failure of delayed fascial closure were peritonitis 1.96 (1.10-3.49) and failure to achieve fascial closure at primary laparotomy 4.70 (2.17-10.2). In the presence of a stoma the HR was 2.02 (1.13-3.63).
  
  
  CONCLUSIONS
  OA using NPWT seems to be a safe procedure, with few procedure-related complications. Failure of fascial closure is related to the indication of OA and the presence of a stoma. Prospective multicenter studies are needed to establish which patients with lower GI surgery benefit from OA.
authors: Department of Surgery, Hillerød University Hospital, University of Copenhagen, Dyrehavevej 29, Hillerød, 3400, Denmark, cabertelsen@gmail.com.
authors: Claus Anders
authors: CA
authors: Bertelsen
authors: Rasmus
authors: R
authors: Fabricius
authors: Jakob
authors: J
authors: Kleif
authors: Bent
authors: B
authors: Kristensen
authors: Ismail
authors: I
authors: Gögenur
mesh_terms: D058107:Abdominal Wound Closure Techniques; D000368:Aged; D013505:Digestive System Surgical Procedures; D004487:Edema / Q000209:etiology / Q000601:surgery; D005205:Fascia / Q000473:pathology; D000071938:Fasciotomy; D005260:Female; D006801:Humans; D007410:Intestinal Diseases / Q000209:etiology / Q000601:surgery; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009336:Necrosis / Q000209:etiology / Q000601:surgery; D054843:Negative-Pressure Wound Therapy; D010538:Peritonitis / Q000209:etiology / Q000601:surgery; D011183:Postoperative Complications / Q000601:surgery*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome