title: Outcomes of primary fascial closure after open abdomen for nontrauma emergency general surgery patients.
abstract: BACKGROUND
  Emergency general surgery patients are increasingly being managed with an open abdomen (OA). Factors associated with complications after primary fascial closure (PFC) are unknown.
  
  
  METHODS
  Demographic and operative variables for all emergency general surgery patients managed with OA at an academic medical center were prospectively examined from June to December 2013. Primary outcome was complication requiring reoperation.
  
  
  RESULTS
  Of 58 patients, 37 managed with OA achieved PFC. Of these, 14 needed re-exploration for dehiscence, compartment syndrome, infection, or other. Complications after PFC were not associated with age, type of operative intervention, time to closure, re-explorations, comorbidities, or mortality. Complications correlated with higher body mass index (P = .02), skin closure (P = .04), plasma infusion (P = .01), and less intraoperative bleeding (P = .05). Deep surgical site infection correlated with fascial dehiscence (P = .02).
  
  
  CONCLUSIONS
  Reoperation after PFC was more likely in obese and nonhemorrhagic patients. Recognition of these factors and strategies to reduce surgical site infection may improve outcomes.
authors.affiliation: Division of Acute Care Surgery, R. Adams Cowley Shock Trauma Center, 22 South Greene Street, Baltimore, MD 21201, USA. Electronic address: Lomeara@umm.edu.
authors.forename: Lindsay
authors.initials: L
authors.lastname: O'Meara
authors.affiliation: Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA.
authors.forename: Sarwat B
authors.initials: SB
authors.lastname: Ahmad
authors.affiliation: Division of Acute Care Surgery, R. Adams Cowley Shock Trauma Center, 22 South Greene Street, Baltimore, MD 21201, USA.
authors.forename: Jacob
authors.initials: J
authors.lastname: Glaser
authors.affiliation: Division of Acute Care Surgery, R. Adams Cowley Shock Trauma Center, 22 South Greene Street, Baltimore, MD 21201, USA; Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA.
authors.forename: Jose J
authors.initials: JJ
authors.lastname: Diaz
authors.affiliation: Division of Acute Care Surgery, R. Adams Cowley Shock Trauma Center, 22 South Greene Street, Baltimore, MD 21201, USA; Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA.
authors.forename: Brandon R
authors.initials: BR
authors.lastname: Bruns
mesh_terms: D058107:Abdominal Wound Closure Techniques; D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical; D015992:Body Mass Index; D000071938:Fasciotomy; D005260:Female; D013502:General Surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control; D011446:Prospective Studies; D012086:Reoperation; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000517:prevention & control; D016896:Treatment Outcome
keywords: Fascial complication; Open abdomen; Surgical site infection