Open abdomen and entero-atmospheric fistulae: An interim analysis from the International Register of Open Abdomen (IROA)

Coccolini F 1 , Ceresoli M 2 , Kluger Y 3 , Kirkpatrick A 4 , Montori G 5 , Salvetti F 6 Show all authors , Fugazzola P 7 , Tomasoni M 8 , Sartelli M 9 , Ansaloni L 10 , Catena F 11 , Negoi I 12 , Zese M 13 , Occhionorelli S 13 , Shlyapnikov S 14 , Galatioto C 15 , Chiarugi M 15 , Demetrashvili Z 16 , Dondossola D 17 , Ioannidis O 18 , Novelli G 19 , Nacoti M 20 , Khor D 21 , Inaba K 21 , Demetriades D 21 , Kaussen T 22 , Jusoh AC 23 , Ghannam W 24 , Sakakushev B 25 , Guetta O 26 , Dogjani A 27 , Costa S 28 , Singh S 29 , Damaskos D 30 , Isik A 31 , Yuan KC 32 , Trotta F 33 , Rausei S 34 , Martinez-Perez A 35 , Bellanova G 36 , Fonseca V 37 , Hernández F 38 , Marinis A 39 , Fernandes W 40 , Quiodettis M 41 , Bala M 42 , Vereczkei A 43 , Curado R 44 , Fraga GP 44 , Pereira BM 44 , Gachabayov M 45 , Chagerben GP 46 , Arellano ML 47 , Ozyazici S 48 , Costa G 49 , Tezcaner T 50 , Porta M 51 , Li Y 52 , Karateke F 53 , Manatakis D 54 , Mariani F 55 , Lora F 56 , Sahderov I 57 , Atanasov B 58 , Zegarra S 59 , Gianotti L 60 , Fattori L 60 , Ivatury R 61

Affiliations 

  • 1 General, Emergency and Trauma Surgery Dept., Bufalini Hospital, Cesena, Italy. Electronic address: Federico.coccolini@gmail.com
  • 2 General and Emergency Surgery, Milano-Bicocca University, School of Medicine and Surgery, Monza, Italy. Electronic address: Marco.ceresoli@libero.it
  • 3 Division of General Surgery Rambam Health Care Campus Haifa, Israel. Electronic address: y_kluger@rambam.health.gov.il
  • 4 Dept. of Surgery, Foothills Medical Centre, Calgary, Canada. Electronic address: Andrew.Kirkpatrick@albertahealthservices.ca
  • 5 General Surgery, San Giovanni Bianco Hospital, Bergamo, Italy. Electronic address: Giulia.montori@gmail.com
  • 6 General, Emergency and Trauma Surgery Dept., Bufalini Hospital, Cesena, Italy. Electronic address: francisalvetti@gmail.com
  • 7 General, Emergency and Trauma Surgery Dept., Bufalini Hospital, Cesena, Italy. Electronic address: paola.fugazzola@gmail.com
  • 8 General, Emergency and Trauma Surgery Dept., Bufalini Hospital, Cesena, Italy. Electronic address: matteo.tomasoni83@gmail.com
  • 9 General and Emergency Surgery, Macerata Hospital, Macerata, Italy. Electronic address: Massimosartelli@gmail.com
  • 10 General, Emergency and Trauma Surgery Dept., Bufalini Hospital, Cesena, Italy. Electronic address: Aiace63@gmail.com
  • 11 Emergency Surgery dept., Parma University Hospital, Parma, Italy. Electronic address: faustocatena@gmail.com
  • 12 Emergency Surgery Hospital, Bucharest, Romania
  • 13 Emergency Surgery dept. Ferrara University Hospital, Ferrara, Italy
  • 14 Science Research of Emergency Care N. A., Djanelidze, Russia
  • 15 Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
  • 16 Kipshidze Central Universtity Hospital, Kipshidze, Georgia
  • 17 HPB Surgery, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milano, Italy
  • 18 Fourth Surgical dept. Hospital George Papanikolau, Aristotle University, Thessaloniki, Greece
  • 19 General Surgery, Infermi Hospital, Rimini, Italy
  • 20 Pediatric Intensive Care Unit, Papa Giovanni XXIII Hospital, Bergamo, Italy
  • 21 LAS+USC Medical Centre, Los Angeles, California
  • 22 Pediatric Intensive Care Unit, Hannover University Hospital, Hannover, Germany
  • 23 KhualaKrai Hospital, Malaysia
  • 24 Mansoura Faculty of Medicine, Egypt
  • 25 Medical University of Plovdiv, Plovdiv, Bulgaria
  • 26 SorokaMedical Centre, Israel
  • 27 University Hospital of Trauma, Albania
  • 28 Emergency and General Surgery, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milano, Italy
  • 29 Oxford University Hospital, United Kindom
  • 30 John Radcliffe Hospital, Oxford
  • 31 Erzincan University Faculty Of Medicine MengucekGazi Training Research Hospital Erzincan, Turkey
  • 32 ChangGungMemorial Hospital, Taiwan
  • 33 Ospedale Maggiore, Lodi, Italy
  • 34 Ospedale di Circolo e Fondazione Macchi, University of Insubria, Varese, Italy
  • 35 Hospital Universitario DoctorPeset, Spain
  • 36 S.S. Annunziata Hospital, Taranto, Italy
  • 37 Hospital Santa Virgínia, São Paulo, Brazil
  • 38 Hospital Central Militar, Mexico
  • 39 Tzaneio General Hospital of Piraeus, Greece
  • 40 Hospital Regional de Sao Jose, Brazil
  • 41 Hospital Santo Tomás, Panama
  • 42 Hadassah Hebrew University Medical Center, Jerusalem, Israel
  • 43 Dept. of Surgery, Medical School University Pécs, Hungary
  • 44 Hospital De Clinicas Da Unicamp, Brazil
  • 45 Vladimir City Clinical Hospital of Emergency Medicine, Russia
  • 46 University Hospital, Ecuador
  • 47 Hospital La Paz, Spain
  • 48 Adana Numune Training and Research Hospital, Department of Surgery, Adana, Turkey
  • 49 Ospedale Sant'Andrea University Hospital Sapienza, Rome, Italy
  • 50 Baskent University School of Medicine, Turkey
  • 51 General Surgery, IRCCS Policlinico San Donato, Milano, Italy
  • 52 Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
  • 53 Numune Training and Research Hospital, Department of Surgery, Numune, Turkey
  • 54 Department of Surgery, Athens Naval and Veterans Hospital, Athens, Greece
  • 55 General Surgery, Santa Maria alleScotteUniversitary Hospital Siena, Italy
  • 56 General Surgery, Cittàdella Salute e dellascienza, Torino, Italy
  • 57 General Surgery, Krasnoyarsk Regional Hospital, Krasnoyarsk, Russia
  • 58 General Surgery, UMHAT"Eurohospital" Plovdiv, Bulgaria
  • 59 General Surgery, Hospital Almenara, Lima, Peru
  • 60 General and Emergency Surgery, Milano-Bicocca University School of Medicine and surgery, Monza, Italy
  • 61 Virginia Commonwealth University, Richmond, Virginia, USA
Injury, 2019 Jan;50(1):160-166.
PMID: 30274755 DOI: 10.1016/j.injury.2018.09.040

Abstract

INTRODUCTION: No definitive data describing associations between cases of Open Abdomen (OA) and Entero-atmospheric fistulae (EAF) exist. The World Society of Emergency Surgery (WSES) and the Panamerican Trauma Society (PTS) thus analyzed the International Register of Open Abdomen (IROA) to assess this question.

MATERIAL AND METHODS: A prospective analysis of adult patients enrolled in the IROA.

RESULTS: Among 649 adult patients with OA 58 (8.9%) developed EAF. Indications for OA were peritonitis (51.2%) and traumatic-injury (16.8%). The most frequently utilized temporary abdominal closure techniques were Commercial-NPWT (46.8%) and Bogotà-bag (21.9%). Mean OA days were 7.9 ± 18.22. Overall mortality rate was 29.7%, with EAF having no impact on mortality. Multivariate analysis associated cancer (p = 0.018), days of OA (p = 0.003) and time to provision-of-nutrition (p = 0.016) with EAF occurrence.

CONCLUSION: Entero-atmospheric fistulas are influenced by the duration of open abdomen treatment and by the nutritional status of the patient. Peritonitis, intestinal anastomosis, negative pressure and oral or enteral nutrition were not risk factors for EAF during OA treatment.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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