title: Open Abdomen Treated with Negative Pressure Wound Therapy: Indications, Management and Survival.
abstract: Open abdomen treatment (OAT) is a significant burden for patients and is associated with considerable mortality. The primary aim of this study was to report survival and cause of mortality after OAT. Secondary aims were to evaluate length of stay (LOS) in intensive care unit (ICU) and in hospital, time to abdominal closure and major complications.
  
  
  
  Retrospective review of prospectively registered patients undergoing OAT between October 2006 and June 2014 at Trondheim University Hospital, Norway.
  
  
  
  The 118 patients with OAT had a median age of 63 (20-88) years. OAT indications were abdominal compartment syndrome (ACS) (n = 53), prophylactic (n = 29), abdominal contamination/second look laparotomy (n = 22), necrotizing fasciitis (n = 7), hemorrhage packing (n = 4) and full-thickness wound dehiscence (n = 3). Eight percent were trauma patients. Vacuum-assisted wound closure (VAWC) with mesh-mediated traction (VAWCM) was used in 92 (78 %) patients, the remaining 26 (22 %) had VAWC only. Per-protocol primary fascial closure rate was 84 %. Median time to abdominal closure was 12 days (1-143). LOS in the ICU was 15 (1-89), and in hospital 29 (1-246) days. Eighty-one (68 %) patients survived the hospital stay. Renal failure requiring renal replacement therapy (RRT) (OR 3.9, 95 % CI 1.37-11.11), ACS (OR 3.1, 95 % CI 1.19-8.29) and advanced age (OR 1.045, 95 % CI 1.004-1.088) were independent predictors of mortality in multivariate analysis. The nine patients with an entero-atmospheric fistula (EAF) survived.
  
  
  
  Two-thirds of the patients treated with OAT survived. Renal failure with RRT, ACS and advanced age were predictors of mortality, whereas EAF was not associated with increased mortality.
authors.affiliation: Departments of Vascular Surgery, St. Olavs Hospital, Trondheim University Hospital, Prinsesse Kristinas gate 3, 7006, Trondheim, Norway. Arne.seternes@stolav.no.|Departments of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Høgskoleringen 1, 7491, Trondheim, Norway. Arne.seternes@stolav.no.|Departments of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), 7006, Trondheim, Norway. Arne.seternes@stolav.no.
authors.forename: A
authors.initials: A
authors.lastname: Seternes
authors.affiliation: Departments of Gastrointestinal Surgery, St. Olavs Hospital, Trondheim University Hospital, Prinsesse Kristinas gate 3, 7006, Trondheim, Norway.
authors.forename: L C
authors.initials: LC
authors.lastname: Rekstad
authors.affiliation: Departments of Anesthesiology and Intensive Care Medicine, St. Olavs Hospital, Trondheim University Hospital, Prinsesse Kristinas gate 3, 7006, Trondheim, Norway.
authors.forename: S
authors.initials: S
authors.lastname: Mo
authors.affiliation: Departments of Anesthesiology and Intensive Care Medicine, St. Olavs Hospital, Trondheim University Hospital, Prinsesse Kristinas gate 3, 7006, Trondheim, Norway.|Departments of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), 7006, Trondheim, Norway.
authors.forename: P
authors.initials: P
authors.lastname: Klepstad
authors.affiliation: Departments of Urologic Surgery, St. Olavs Hospital, Trondheim University Hospital, Prinsesse Kristinas gate 3, 7006, Trondheim, Norway.
authors.forename: D L
authors.initials: DL
authors.lastname: Halvorsen
authors.affiliation: Departments of Vascular Surgery, St. Olavs Hospital, Trondheim University Hospital, Prinsesse Kristinas gate 3, 7006, Trondheim, Norway.|Departments of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), 7006, Trondheim, Norway.
authors.forename: T
authors.initials: T
authors.lastname: Dahl
authors.affiliation: Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, 751 85, Uppsala, Sweden.
authors.forename: M
authors.initials: M
authors.lastname: Björck
authors.affiliation: Departments of Gastrointestinal Surgery, St. Olavs Hospital, Trondheim University Hospital, Prinsesse Kristinas gate 3, 7006, Trondheim, Norway.|Departments of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Høgskoleringen 1, 7491, Trondheim, Norway.
authors.forename: A
authors.initials: A
authors.lastname: Wibe
mesh_terms: D000007:Abdominal Injuries / Q000401:mortality / Q000601:surgery; D058107:Abdominal Wound Closure Techniques / Q000009:adverse effects / Q000401:mortality; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019115:Fasciitis, Necrotizing / Q000401:mortality / Q000601:surgery; D005260:Female; D006470:Hemorrhage / Q000401:mortality / Q000601:surgery; D006801:Humans; D059325:Intra-Abdominal Hypertension / Q000401:mortality / Q000601:surgery; D007813:Laparotomy; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D054843:Negative-Pressure Wound Therapy / Q000009:adverse effects / Q000401:mortality; D012189:Retrospective Studies; D013529:Surgical Wound Dehiscence / Q000401:mortality / Q000601:surgery; D015996:Survival Rate; D016896:Treatment Outcome