Superior primary fascial closure rate and lower mortality after open abdomen using negative pressure wound therapy with continuous fascial traction.

BACKGROUND Open abdomen (OA) is a useful option for treatment strategy in many acute abdominal catastrophes. A number of temporary abdominal closure (TAC) methods are used with limited number of comparative studies. The present study was done to examine risk factors for failed delayed primary fascial closure (DPFC) and risk factors for mortality in patients treated with OA. METHODS This study was a multicenter retrospective analysis of the hospital records of all consecutive patients treated with OA during the years 2009-2016 at 5 tertiary referral hospitals and 3 secondary referral centers in Finland. RESULTS 676 patients treated with OA were included in the study. Vacuum-assisted closure with continuous mesh-mediated fascial traction (VACM) was the most popular TAC method used (N=398, 59%) followed by VAC (N=128, 19%), Bogota bag (N=128, 19%) and self-designed methods (N=22, 3%). In multivariate analysis enteroathmospheric fistula and the number of needed TAC changes increased the risk for failed DPFC (OR=8.9, 95%C.I. 6.2-12.8, P<.001 and OR=1.1, 95% CI, 1.0-1.3, P<.001, respectively). Instead VACM and ruptured abdominal aortic aneurysm as cause for OA both decreased the risk for failed DPFC (OR=0.1, 95%C.I. 0.0-0.3, P<.001 and OR=0.2, 95%C.I. 0.1-0.7, P = .012). The overall mortality rate was 30%. In multivariate analysis for mortality, multi organ dysfunction (OR=2.4, 95%C.I. 1.6-3.6, P<.001) and increasing age (OR=4.5, 95%C.I. 2.0-9.7, P<,001) predicted increased mortality. Institutional large annual patient volume (OR=0.4 95%C.I. 0.3-0.6, P<.001) and ileus and postoperative peritonitis in comparison to SAP associated with decreased mortality (OR=0.2 95%C.I. 0.1-0.4, P<.001; OR=0.5 95%C.I. 0.3-0.8, P=.009). Kaplan-Meier analysis showed increased survival in patients treated with VACM in comparison with other TAC methods (LogRank P=.019). CONCLUSIONS We report superior role for VACM methodology in terms of successful primary fascial closure and increased survival in patients with OA. LEVEL OF EVIDENCE III (therapeutic/care management).