Francesca Margherita Bunino (Pieve Emanuele / IT; Rozzano / IT), Simone Famularo (Rozzano / IT), Giulia Mauri (Rozzano / IT; Pieve Emanuele / IT), Girogia Willy Landini Persichetti (Pieve Emanuele / IT), Simone Giudici (Rozzano / IT; Pieve Emanuele / IT), Martina Ceolin (Rozzano / IT), Simona Mei (Rozzano / IT), Antonella Ardito (Rozzano / IT), Andrea Brocchi (Rozzano / IT), Bruno Branciforte (Rozzano / IT), Daniele Del Fabbro (Rozzano / IT)
Abstract text (incl. references and figure legends)
I:Open Abdomen (OA) is getting consensus in the emergency surgery community (ES) but its effectiveness is still debated. Our aim was to estimate the 90-days mortality in nontrauma patients (pts) who underwent OA vs definitive primary closure (DC) during emergency laparotomy (EL).
M:Consecutive pts who underwent EL at the IRCCS-HumanitasResearchHospital between 01/2015 and 12/2022 were reviewed and divided in two groups (OA vs DC). Differences were balanced by inverse probability weighting (IPW), and 90-day mortality was estimated by Kaplan-Meier method. Subgroup analysis was carried out for pts with Manheim score>26 (MS), or with a diagnosis of bowel obstruction (BO), bowel ischaemia (BI), perforation (PE).
R:320 pts were enrolled, 167 DC and 153 OA. Groups were significantly different for ASA, Charlson Index (CI), Transfusions rate, P-Possum score, Manheim score grade, Clinical Frailty scale Score (CFSS), diagnosis and type of resection. After IPW, two pseudo populations were created: 227 DC and 186 OA. The 90-day mortality was 50.8% for DC and 60.8% for OA (HR0.793,95%CI:0.40-1.55,p:0.502,fig.1A). At Cox regression, CFSS (HR 1.125,95%CI:1.01-1.25,p:0.033), BI (HR5.531,95%CI:2.37-12.89,p<0.001) and No-resection (HR 2.970,95%CI: 1.56-6.64,p:0.001) resulted being predictors of 90-day mortality. OA did not modify the risk of 90-days mortality in case of MS, BO and PE. In case of BI, performing OA (HR0.056,95%CI:0.01-0.22,p:0.001, fig.1B), P-Possum score (HR1.060,95%CI:1.01-1.11,p:0.033), large bowel resection (HR6.442,95%CI:1.28-32.31,p:0.040) and No-resection (HR9.880,95%CI:3.01-32.35,p:0.002) were predictors of death.
C:OA is not superior to DC in most of the setting explored, even in case of severe peritonitis. Bowel ischaemia is the only setting in which OA reduce the risk of mortality.
R:Proaño-Zamudio JA,Delayed fascial closure in nontrauma abdominal emergencies: A nationwide analysis.Surgery.2022 Nov;doi:10.1016/j.surg.2022.06.025.
Fig1A-B. 90-Day survival
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