title: Intensive care and health outcomes of open abdominal treatment: long-term results of vacuum-assisted wound closure and mesh-mediated fascial traction (VAWCM).
abstract: OBJECTIVE
  The study's purpose is to evaluate the long-term outcome after vacuum-assisted wound closure and mesh-mediated fascial traction (VAWCM) and to identify predictors of quality of life associated with intensive care.
  
  
  METHODS
  Fifty-five patients who underwent open abdomen management at our institution from 2006 to 2013 were prospectively enrolled in this study. After a median follow-up period of 3.8 years, 27 patients completed the 36-Item Short Form Survey (SF-36) quality of life questionnaire. As this is a report solely focused on quality of life, direct treatment-related outcome measures like mortality, closure rates, and incisional hernia development of this study cohort have been reported previously.
  
  
  RESULTS
  SF-36 physical role (54.6 ± 41.0 (0-100), p < 0.01), physical functioning (68.4 ± 29.5 (0-100), p = 0.01), and physical component summary (41.6 ± 13.0 (19-62), p = 0.01) scores for the patient population were significantly lower than normative scores. Significant correlations were found between physical functioning and total treatment costs (r = -0.66, p = 0.01), total units of packed red blood cells (r = -0.56, p = 0.04), and the complex intensive care scores (r = -0.50, p = 0.02). Simple and multiple regression analyses demonstrated that the complex intensive care score was the only predictor of physical functioning (R2= 0.50, β = -0.70, p = 0.02).
  
  
  CONCLUSIONS
  Despite high short-term mortality and morbidity rates for these critically ill patients, open abdomen treatment using VAWCM allows patients to recover to an acceptable long-term quality of life. The complex intensive care score can be used as a surrogate parameter for the global severity of illness and was the only predictor of physical functioning (SF-36).
authors.affiliation: Department of General, Visceral and Thoracic Surgery, German Armed Forces Central Hospital of Koblenz, Koblenz, Germany. ArnulfWillms@gmx.de.
authors.forename: A
authors.initials: A
authors.lastname: Willms
authors.affiliation: Department of General, Visceral and Thoracic Surgery, German Armed Forces Central Hospital of Koblenz, Koblenz, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Schaaf
authors.affiliation: Department of General, Visceral and Thoracic Surgery, German Armed Forces Central Hospital of Koblenz, Koblenz, Germany.
authors.forename: R
authors.initials: R
authors.lastname: Schwab
authors.affiliation: Department of General, Visceral and Thoracic Surgery, German Armed Forces Central Hospital of Koblenz, Koblenz, Germany.
authors.forename: I
authors.initials: I
authors.lastname: Richardsen
authors.affiliation: Department of Anesthesiology and Intensive Care, German Armed Forces Central Hospital of Koblenz, Koblenz, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Jänig
authors.affiliation: Department of Trauma Surgery and Orthopedics, Plastic and Reconstructive Surgery, and Hand Surgery, German Armed Forces Central Hospital of Koblenz, Koblenz, Germany.
authors.forename: D
authors.initials: D
authors.lastname: Bieler
authors.affiliation: Support Division of the Directorate-General for Strategy and Operations, Federal Ministry of Defense, Berlin, Germany.
authors.forename: B
authors.initials: B
authors.lastname: Wagner
authors.affiliation: Department of General, Visceral and Thoracic Surgery, German Armed Forces Central Hospital of Koblenz, Koblenz, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Güsgen
mesh_terms: D058107:Abdominal Wound Closure Techniques; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003422:Critical Care; D000071938:Fasciotomy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D000069290:Incisional Hernia / Q000453:epidemiology; D007813:Laparotomy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D054843:Negative-Pressure Wound Therapy; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D011788:Quality of Life; D013526:Surgical Mesh; D011795:Surveys and Questionnaires; D013997:Time Factors; D014143:Traction; D016896:Treatment Outcome; D055815:Young Adult
keywords: Abdominal compartment syndrome; Abdominal trauma; Abdominal wall closure; Follow-up; Incisional hernia; Laparostomy; Negative pressure therapy; Open abdomen; Outcome; Peritonitis