2017 Resarch Forum

SG: M-3

Applicant: Geoffrey C Darby MD Principal Investigator: Maureen Martin MD FACS

Negative pressure wound therapy for open abdomen treatment: Analysis of outcomes and factors affecting fascial closure Geoffrey C Darby MD, Avneet Nijjar MS III, Andrea Pakula MD MPH FACS, Ruby Skinner MD FACS FCCP FCCM, Maureen Martin MD FACS

INTRODUCTION : Negative pressure wound therapy (NPWT) has emerged as an important management strategy for wound coverage when fascia closure is deferred in patients following damage control surgery. PURPOSE: We aimed to analyze risk factors contributing to complications, timing failure of wound closure and risk of fistula development in acute care and trauma settings. METHOD: Local IRB approval was obtained to query medical records of all patients with open abdomen (OA) following damage control general surgery (GS) and trauma (T) treated with NPWT from January 2015 to July 2016. Patients were divided into 2 groups based on etiology; trauma (Group 1) and acute general surgery (Group 2). Multivariate analysis of risk factors was performed. RESULTS: 103 patients were identified with a mean age of 36+16 vs. 51 +15 years (p=0.001) and mean BMI of 27 vs. 30 for T and GS respectively. Comorbidities were higher in GS compared to T, 8/40 GS (20%) vs. 4/63 T (6.3%) p<.05 but did not significantly impact fascia closure rates (9% vs. 16% p=0.32 ).

Group I Trauma

Group II GS

P Value

Prior Surgery

11

30

0.001

TOTAL LOS (days)

20±19

20±15

ICU LOS (days)

7±6 11% 23%

6±4 12% 25%

Mortality Infections

Fistula

4%

0%

Reoperations

1.2+1.2

0.85+1.2

0.3

Readmission (30 day)

19% 80% 30% 14%

27% 60% 33% 30%

0.05 0.25

Primary Closure

Fascia

Skin only

0.001

Table 1: Outcomes of patients receiving NPWT . DISCUSSION/CONCLUSIONS: Open abdomen management of life threatening intra-abdominal events with NPWT appears safe with a low re-operative and fistula rate for both T and GS patients. Primary fascia closure is achieved in the majority of patients in both groups however skin only closure and hospital readmissions are significantly higher in GS patients. Further studies are needed to define patient population, guidelines and device application to optimize patient care.