title: Open abdomen with negative pressure device vs primary abdominal closure for the management of surgical abdominal sepsis: a retrospective review.
abstract: BACKGROUND
  Open abdomen with temporary abdominal closure remains a controversial management strategy for surgical abdominal sepsis compared with primary abdominal closure (PAC) and on-demand laparotomy. The primary objective was to compare mortality between PAC and open abdomen with vacuum assisted closure (VAC).
  
  
  METHODS
  Retrospective review of a tertiary center intensive care unit database (2006 to 2010) including suspected/diagnosed severe abdominal sepsis/septic shock requiring source control laparotomy. Groups were categorized according to closure method at index source control laparotomy. APACHE-IV was used as a measure of disease severity.
  
  
  RESULTS
  Of 211 patients, 75 PAC and 136 VAC cases were included. Controlling for disease severity, adjusted odds ratio of mortality for VAC was .41 95% confidence interval (.21, .81; P = .01) compared with PAC. PAC and VAC APACHE-1V predicted mortality rate were both 45%. VAC mortality was lower than PAC (22.8% vs 38.6%; P = .012).
  
  
  CONCLUSIONS
  Open abdomen with VAC is associated with significantly improved survival compared with PAC in abdominal sepsis requiring laparotomy.
authors.affiliation: Division of General Surgery, Department of General Surgery, University of British Columbia, Vancouver General Hospital Rm 3100-Jim Pattison Pavillion North, 950 West 10th Avenue, Vancouver, British Columbia V5Z 1M9, Canada. Electronic address: mbleszyn@gmail.com.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Bleszynski
authors.affiliation: Division of General Surgery, Department of General Surgery, University of British Columbia, Vancouver General Hospital Rm 3100-Jim Pattison Pavillion North, 950 West 10th Avenue, Vancouver, British Columbia V5Z 1M9, Canada.
authors.forename: Tiffany
authors.initials: T
authors.lastname: Chan
authors.affiliation: Division of General Surgery, Department of General Surgery, University of British Columbia, Vancouver General Hospital Rm 3100-Jim Pattison Pavillion North, 950 West 10th Avenue, Vancouver, British Columbia V5Z 1M9, Canada.
authors.forename: Andrzej K
authors.initials: AK
authors.lastname: Buczkowski
mesh_terms: D018806:APACHE; D000005:Abdomen / Q000601:surgery; D000328:Adult; D000368:Aged; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D007813:Laparotomy / Q000009:adverse effects* / Q000379:methods; D008297:Male; D008875:Middle Aged; D054843:Negative-Pressure Wound Therapy / Q000379:methods*; D012189:Retrospective Studies; D018570:Risk Assessment; D018805:Sepsis / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D013529:Surgical Wound Dehiscence / Q000382:microbiology / Q000628:therapy*; D015996:Survival Rate; D062606:Tertiary Care Centers; D016896:Treatment Outcome; D058106:Wound Closure Techniques; D014945:Wound Healing / Q000502:physiology*
keywords: APACHE-1V; Abdominal sepsis; On-demand laparotomy; Open abdomen; Vacuum assisted closure