Who would benefit from open abdomen in severe acute pancreatitis?-a matched case-control study

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Husu , H L , Leppäniemi , A K & Mentula , P J 2021 , ' Who would benefit from open abdomen in severe acute pancreatitis?-a matched case-control study ' , World journal of emergency surgery , vol. 16 , no. 1 , 32 . https://doi.org/10.1186/s13017-021-00376-x

Title: Who would benefit from open abdomen in severe acute pancreatitis?-a matched case-control study
Author: Husu, Henrik Leonard; Leppäniemi, Ari Kalevi; Mentula, Panu Juhani
Contributor organization: II kirurgian klinikka
University of Helsinki
Helsinki University Hospital Area
HUS Abdominal Center
Staff Services
Date: 2021-06-10
Language: eng
Number of pages: 8
Belongs to series: World journal of emergency surgery
ISSN: 1749-7922
DOI: https://doi.org/10.1186/s13017-021-00376-x
URI: http://hdl.handle.net/10138/332368
Abstract: Background Selection of patients for open abdomen (OA) treatment in severe acute pancreatitis (SAP) is challenging. Treatment related morbidity and risk of adverse events are high; however, refractory abdominal compartment syndrome (ACS) is potentially lethal. Factors influencing the decision to initiate OA treatment are clinically important. We aimed to study these factors to help understand what influences the selection of patients for OA treatment in SAP. Methods A single center study of patients with SAP that underwent OA treatment compared with conservatively treated matched controls. Results Within study period, 47 patients treated with OA were matched in a 1:1 fashion with conservatively treated control patients. Urinary output under 20 ml/h (OR 5.0 95% CI 1.8-13.7) and ACS (OR 4.6 95% CI 1.4-15.2) independently associated with OA treatment. Patients with OA treatment had significantly more often visceral ischemia (34%) than controls (6%), P = 0.002. Mortality among patients with visceral ischemia was 63%. Clinically meaningful parameters predicting developing ischemia were not found. OA treatment associated with higher overall 90-day mortality rate (43% vs 17%, P = 0.012) and increased need for necrosectomy (55% vs 21%, P = 0.001). Delayed primary fascial closure was achieved in 33 (97%) patients that survived past OA treatment. Conclusion Decreased urine output and ACS were independently associated with the choice of OA treatment in patients with SAP. Underlying visceral ischemia was strikingly common in patients undergoing OA treatment, but predicting ischemia in these patients seems difficult.
Subject: 3126 Surgery, anesthesiology, intensive care, radiology
Abdominal compartment syndrome
Abdominal vac
Acute pancreatitis
Circulatory failure
Intra-abdominal hypertension
Multiple organ failure
Necrotizing pancreatitis
Negative-pressure wound therapy
Open abdomen
Organ failure
Renal failure
Severe acute pancreatitis
Vacuum-assisted wound closure
Mesh-mediated fascial traction
Peer reviewed: Yes
Rights: cc_by
Usage restriction: openAccess
Self-archived version: publishedVersion

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