title: Open abdomen management of intra-abdominal infections: analysis of a twenty-year experience.
abstract: BACKGROUND
  No conclusive results on the efficacy and timing of open abdomen (OA) are available, particularly in the setting of intra-abdominal infections. We analyzed outcomes and risk factors retrospectively in a large series of patients managed with an OA during the past 20 y in an effort to clarify this issue.
  
  
  METHODS
  We reviewed the records of 133 patients who underwent treatment with an OA, considering factors related to patient, disease, medical management, and surgical treatment. The end points of the bi-variable analysis were 1-y mortality, calculated from the time of an initial OA procedure, and definitive fascial closure.
  
  
  RESULTS
  Most patients (112/133) managed with an OA had one of several types of peritonitis. Many patients had severe clinical conditions (mean Acute Physiology and Chronic Health Evaluation [APACHE] II score was almost 9 points for the study population). With regard to surgical management, the mean (+SD) number of abdominal revisions was 5.9+9.3 during a mean duration of treatment with an OA of 14.3+11.6 d. The overall mortality in the study was 26% (35/133). Bi-variable analysis revealed factors associated with overall mortality to be age, renal and respiratory co-morbidities, edema on an initial chest radiograph, blood pressure, blood glucose and creatinine concentrations; and APACHE II score. The rate of definitive fascial closure was 75% (100/133). Factors associated negatively with fascial closure were respiratory co-morbidity, edema on a first chest radiograph, post-operative mesenteric ischemia as an indication for OA, blood glucose and creatinine concentrations, and duration of an OA.
  
  
  CONCLUSIONS
  Patients' pre-operative clinical status influences strongly their response to surgical treatment. The management of OA does not affect adversely the survival of patients with intra-abdominal infections, but factors related to the management of OA (duration of OA) seem to affect the possibility of definitive fascial closure.
authors.affiliation: 1 Department of Surgery, University of Insubria , Varese, Italy .
authors.forename: Stefano
authors.initials: S
authors.lastname: Rausei
authors.forename: Gianlorenzo
authors.initials: G
authors.lastname: Dionigi
authors.forename: Luigi
authors.initials: L
authors.lastname: Boni
authors.forename: Francesca
authors.initials: F
authors.lastname: Rovera
authors.forename: Giulio
authors.initials: G
authors.lastname: Minoja
authors.forename: Salvatore
authors.initials: S
authors.lastname: Cuffari
authors.forename: Renzo
authors.initials: R
authors.lastname: Dionigi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D059413:Intraabdominal Infections / Q000401:mortality* / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome