Open abdomen with negative pressure device vs primary abdominal closure for the management of surgical abdominal sepsis: a retrospective review.

ABSTRACT

BACKGROUND: Open abdomen with temporary abdominal closure remains a controversial management strategy for surgical abdominal sepsis compared with primary abdominal closure (PAC) and on-demand laparotomy. The primary objective was to compare mortality between PAC and open abdomen with vacuum assisted closure (VAC). METHODS: Retrospective review of a tertiary center intensive care unit database (2006 to 2010) including suspected/diagnosed severe abdominal sepsis/septic shock requiring source control laparotomy. Groups were categorized according to closure method at index source control laparotomy. APACHE-IV was used as a measure of disease severity. RESULTS: Of 211 patients, 75 PAC and 136 VAC cases were included. Controlling for disease severity, adjusted odds ratio of mortality for VAC was .41 95% confidence interval (.21, .81; P = .01) compared with PAC. PAC and VAC APACHE-1V predicted mortality rate were both 45%. VAC mortality was lower than PAC (22.8% vs 38.6%; P = .012). CONCLUSIONS: Open abdomen with VAC is associated with significantly improved survival compared with PAC in abdominal sepsis requiring laparotomy.