O050 Does Fast Track Perioperative Care Have a Positive Metabolic Effect for Patients After Intestinal Resections?

Šerclová, Zuzana; Marvan, Jaroslav; Dytrych, Petr; Antoš, F; Ryska, O; Hankeová, Zuzana; Slegrova, Z.

doi:10.1016/s1744-1161(08)70052-8

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“…Comparisons between immediate fascial closure and TAC for the septic abdomen have had conflicting results. One prospective randomized trial found that among patients with severe peritonitis undergoing laparotomy, mortality was lower for patients managed with TAC compared with closure at initial laparotomy (11% vs. 41%, p=0.01) (35). A retrospective review of critically ill patients with intra-abdominal sepsis managed with TAC and planned relaparotomy versus immediate abdominal closure at initial laparotomy found that ICU and hospital length of stay were significantly longer in the TAC cohort with no difference in mortality (36).…”

Section: Discussionmentioning

confidence: 99%

The impact of standardized protocol implementation for surgical damage control and temporary abdominal closure after emergent laparotomy

Loftus

Efron

Bala

et al. 2019

J Trauma Acute Care Surg

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Background: To standardize care and promote early fascial closure among patients undergoing emergent laparotomy and temporary abdominal closure (TAC), we developed a protocol addressing patient selection, operative technique, resuscitation strategies, and critical care provisions. We hypothesized that primary fascial closure rates would increase following protocol implementation with no difference in complication rates. Study Design:We performed a retrospective cohort analysis of 138 adult trauma and emergency general surgery patients who underwent emergent laparotomy and TAC, comparing protocol patients (n=60) to recent historic controls (n=78) that would have met protocol inclusion criteria. The protocol includes low volume 3% hypertonic saline resuscitation, judicious wound vacuum fluid replacement, and early relaparotomy with sequential fascial closure. Demographics, baseline characteristics, illness severity, resuscitation course, operative management, and outcomes were compared. The primary outcome was fascial closure.Results: Baseline characteristics, including age, ASA class and postoperative lactate levels were similar between groups. Within 48 hours of initial laparotomy and TAC, protocol patients received significantly lower total intravenous fluid resuscitation volumes (9.7 vs. 11.4 L, p=0.044) and exhibited higher serum osmolarity (303 vs. 293 mosm/kg, p=0.001). The interval between abdominal operations was significantly shorter following protocol implementation (28.2 vs. 32.2 hours, p=0.027). The incidence of primary fascial closure was significantly higher in the protocol group (93% vs. 81%, p=0.045, number needed to treat: 8.3). Complication rates were similar between groups.

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Section: Discussionmentioning

confidence: 99%