IROA: International Register of Open Abdomen, preliminary results

Abstract

BackgroundNo definitive data about open abdomen (OA) epidemiology and outcomes exist. The World Society of Emergency Surgery (WSES) and the Panamerican Trauma Society (PTS) promoted the International Register of Open Abdomen (IROA).MethodsA prospective observational cohort study including patients with an OA treatment. Data were recorded on a web platform (Clinical Registers®) through a dedicated website: www.clinicalregisters.org.ResultsFour hundred two patients enrolled. Adult patients: 369 patients; Mean age: 57.39±18.37; 56% male; Mean BMI: 36±5.6. OA indication: Peritonitis (48.7%), Trauma (20.5%), Vascular Emergencies/Hemorrhage (9.4%), Ischemia (9.1%), Pancreatitis (4.2%),Post-operative abdominal-compartment-syndrome (3.9%), Others (4.2%). The most adopted Temporary-abdominal-closure systems were the commercial negative pressure ones (44.2%). During OA 38% of patients had complications; among them 10.5% had fistula. Definitive closure: 82.8%; Mortality during treatment: 17.2%. Mean duration of OA: 5.39(±4.83) days; Mean number of dressing changes: 0.88(±0.88). After-closure complications: (49.5%) and Mortality: (9%). No significant associations among TACT, indications, mortality, complications and fistula. A linear correlationexists between days of OA and complications (Pearson linear correlation = 0.326 p<0.0001) and with the fistula development (Pearson = 0.146 p= 0.016).Pediatric patients: 33 patients. Mean age: 5.91±(3.68) years; 60% male. Mortality: 3.4%; Complications: 44.8%; Fistula: 3.4%. Mean duration of OA: 3.22(±3.09) days.ConclusionTemporary abdominal closure is reliable and safe. The different techniques account for different results according to the different indications. In peritonitis commercial negative pressure temporary closure seems to improve results. In trauma skin-closure and Bogotà-bag seem to improve results.Trial registrationClinicalTrials.gov NCT02382770

Manejo Del Abdomen Abierto: Desde La Operación Inicial Al Cierre Definitivo

“…En reuniones sucesivas en los años 2007-2009 y 2013, se fueron optimizando algunas definiciones que son las más aceptadas en la actualidad [2][3][4] . Por otro lado la Sociedad Mundial de Cirugía de Emergencia (WSES) promovió el Registro Internacional del Abdomen Abierto (IROA), con la finalidad de que médicos de todo el mundo ingresen sus pacientes y que su análisis contribuya al mayor entendimiento del AA y a mejorar sus resultados 15,16 .…”

“…Resultados: en febrero de 2017, el IROA (Registro Internacional de Abdomen Abierto) publica los resultados preliminares de un trabajo observacional y prospectivo, que incluye pacientes con un tratamiento de abdomen abierto 15 . Se registraron 339 pacientes adultos, con una edad media de 57 años.…”

“…muestra la utilidad y la adhesión de los cirujanos a la estrategia de control de daños y el AA y C en el tratamiento de las peritonitis graves (48% de los casos en este informe) 15 . El dato es coincidente con los aportados por Acosta y cols.…”

Temporary abdominal closure techniques in open abdomen: preliminary data of international register of open abdomen (IROA): patient enrollment is still ongoing

“…The analysis of the results can clarify the role of the different OA techniques used. In fact, as it is emerging in our preliminary data the non-commercial negative pressure devices are largely used in many centres [6]. In fact, in many centres, the commercial devices cannot use for several reasons.…”

“…Some of the aims of IROA would be to reduce this lack of data and e to evaluate the role of OA techniques in different indications and settings [6]. For surely many limits of this prospective register exist: different techniques, different area of the world, different surgeons and different indications are included.…”