Outcomes and associated factors of open abdomen after urgent laparotomy at a University Hospital in Southern Brazil: a retrospective study.

INTRODUCTION: The technique of open abdomen refers to a surgical procedure that intentionally involves leaving an opening in the abdominal wall. This study aimed to evaluate the clinical outcomes, mortality, and morbidity of patients undergoing open abdomen in a public hospital in Brazil and investigate associated risk factors associated with the outcome. METHODS: Data from electronic medical records were collected from 2017 to 2022. The variables were used for descriptive analyses, association analysis, and survival analysis using the Kaplan-Meier curve. RESULTS: The sample included 104 patients, with 84 presenting with acute abdomen and 20 with trauma, having highly variable ages and comorbidities. Peritonitis and the need for early reoperation were the most common indication for the procedure, each accounting for 34%, and negative pressure wound therapy was the most commonly used technique. Fistula was the most frequent complication, with the majority forming in the early days after the surgery. The number of interventions and open abdomen time obtained statistical significance in comparison with the outcome. The overall mortality rate was 62,5%. CONCLUSION: Despite open abdomen being a technique that can have benefits in controlling intraabdominal contamination and preventing abdominal compartment syndrome, its implementation is associated with complications. The mortality and complication rates were high in this sample. The decision to use the technique should be individualized and based on several factors, including the indications and the patient's clinical status.

Open or closed abdomen post laparotomy to control severe abdominal sepsis: a survival analysis.

INTRODUCTION: severe abdominal sepsis, accompained by diffuse peritonitis, poses a significant challenge for most surgeons. It often requires repetitive surgical interventions, leading to complications and resulting in high morbidity and mortality rates. The open abdomen technique, facilitated by applying a negative-pressure wound therapy (NPWT), reduces the duration of the initial surgical procedure, minimizes the accumulation of secretions and inflammatory mediators in the abdominal cavity and lowers the risk of abdominal compartment syndrome and its associated complications. Another approach is primary closure of the abdominal aponeurosis, which involves suturing the layers of the abdominal wall. METHODS: the objective of this study is to conduct a survival analysis comparing the treatment of severe abdominal sepsis using open abdomen technique versus primary closure after laparotomy in a public hospital in the South of Brazil. We utilized data extracted from electronic medical records to perform both descriptive and survival analysis, employing the Kaplan-Meier curve and a log-rank test. RESULTS: the study sample encompassed 75 laparotomies conducted over a span of 5 years, with 40 cases employing NPWT and 35 cases utilizing primary closure. The overall mortality rate observed was 55%. Notably, survival rates did not exhibit statistical significance when comparing the two methods, even after stratifying the data into separate analysis groups for each technique. CONCLUSION: recent publications on this subject have reported some favorable outcomes associated with the open abdomen technique underscoring the pressing need for a standardized approach to managing patients with severe, complicated abdominal sepsis.

Outcomes and associated factors of open abdomen after urgent laparotomy at a University Hospital in Southern Brazil: a retrospective study / Desfechos e fatores associados em pacientes submetidos ao abdome aberto após laparotomia de urgência em um Hospital Universitário no sul do Brasil: um estudo retrospectivo

ABSTRACT Introduction: The technique of open abdomen refers to a surgical procedure that intentionally involves leaving an opening in the abdominal wall. This study aimed to evaluate the clinical outcomes, mortality, and morbidity of patients undergoing open abdomen in a public hospital in Brazil and investigate associated risk factors associated with the outcome. Methods: Data from electronic medical records were collected from 2017 to 2022. The variables were used for descriptive analyses, association analysis, and survival analysis using the Kaplan-Meier curve. Results: The sample included 104 patients, with 84 presenting with acute abdomen and 20 with trauma, having highly variable ages and comorbidities. Peritonitis and the need for early reoperation were the most common indication for the procedure, each accounting for 34%, and negative pressure wound therapy was the most commonly used technique. Fistula was the most frequent complication, with the majority forming in the early days after the surgery. The number of interventions and open abdomen time obtained statistical significance in comparison with the outcome. The overall mortality rate was 62,5%. Conclusion: Despite open abdomen being a technique that can have benefits in controlling intraabdominal contamination and preventing abdominal compartment syndrome, its implementation is associated with complications. The mortality and complication rates were high in this sample. The decision to use the technique should be individualized and based on several factors, including the indications and the patient's clinical status.

RESUMO Introdução: A técnica de abdome aberto refere-se a um procedimento cirúrgico que envolve deixar deliberadamente uma abertura na parede abdominal. Este estudo teve como objetivo avaliar o desfecho clínico, mortalidade e morbidade de pacientes submetidos ao abdome aberto em um hospital público do Brasil e investigar fatores de risco associados ao desfecho. Métodos: Dados a partir de prontuários eletrônicos foram coletados de 2017 a 2022. As variáveis foram utilizadas para análises descritivas, análise de associação e de sobrevivência pela curva Kaplan-Meier. Resultados: A amostra correspondeu a 104 pacientes, sendo 84 por abdome agudo e 20 por trauma, com idade e número de comorbidades variados. A peritonite e a necessidade de reabordagem precoce foram as causas mais comuns para a indicação do procedimento, 34% cada, e a terapia de pressão negativa foi a mais utilizada neste estudo, seguindo a técnica de Barker. Fístula é a complicação mais frequente (41%), sendo que a maioria se formou nos primeiros dias após a realização da cirurgia. O número de intervenções e o tempo de abdome aberto obtiveram significância estatística na comparação com o desfecho. A mortalidade geral foi de 62,5%. Conclusão: Apesar de o abdome aberto ser uma técnica que pode trazer benefícios no controle da contaminação intra-abdominal e prevenção de síndrome compartimental abdominal, sua realização está associada a complicações. A taxa de mortalidade e morbidade foram elevadas nesta amostra. A decisão para uso da técnica deve ser individualizada e baseada em vários fatores, incluindo as indicações e o estado clínico do paciente.

Open or closed abdomen post laparotomy to control severe abdominal sepsis: a survival analysis / Abdome aberto ou fechado pós-laparotomia para controle de sepse de foco intra-abdominal severa: uma análise de sobrevivência

ABSTRACT Introduction: severe abdominal sepsis, accompained by diffuse peritonitis, poses a significant challenge for most surgeons. It often requires repetitive surgical interventions, leading to complications and resulting in high morbidity and mortality rates. The open abdomen technique, facilitated by applying a negative-pressure wound therapy (NPWT), reduces the duration of the initial surgical procedure, minimizes the accumulation of secretions and inflammatory mediators in the abdominal cavity and lowers the risk of abdominal compartment syndrome and its associated complications. Another approach is primary closure of the abdominal aponeurosis, which involves suturing the layers of the abdominal wall. Methods: the objective of this study is to conduct a survival analysis comparing the treatment of severe abdominal sepsis using open abdomen technique versus primary closure after laparotomy in a public hospital in the South of Brazil. We utilized data extracted from electronic medical records to perform both descriptive and survival analysis, employing the Kaplan-Meier curve and a log-rank test. Results: the study sample encompassed 75 laparotomies conducted over a span of 5 years, with 40 cases employing NPWT and 35 cases utilizing primary closure. The overall mortality rate observed was 55%. Notably, survival rates did not exhibit statistical significance when comparing the two methods, even after stratifying the data into separate analysis groups for each technique. Conclusion: recent publications on this subject have reported some favorable outcomes associated with the open abdomen technique underscoring the pressing need for a standardized approach to managing patients with severe, complicated abdominal sepsis.

RESUMO Introdução: a sepse abdominal grave, com peritonite difusa, é um grande desafio para o cirurgião geral, sendo muito frequente as reintervenções cirúrgicas e complicações desta doença, que apresenta morbimortalidade elevada. A proposta do abdome aberto, aplicando-se a terapia por pressão negativa (TPN), reduz o tempo operatório da primeira abordagem cirúrgica, reduz o acúmulo de secreções e mediadores inflamatórios no sítio abdominal, diminui a possibilidade de síndrome compartimental abdominal e suas complicações. A outra técnica é a síntese primária, quando é optado por fechar a parede por completo. Métodos: o objetivo do estudo foi realizar uma análise de sobrevivência comparando os tratamentos de sepse intra-abdominal severa com Abdome Aberto e Fechado após laparotomia em um hospital universitário no sul do Brasil. As variáveis foram obtidas a partir de prontuários eletrônicos de pacientes submetidos à intervenção cirúrgica e realizou-se uma análise descritiva e de sobrevivência usando a curva de Kaplan-Meier e o teste de log-rank. Resultados: a amostra incluiu 75 laparotomias em 5 anos (40 TPN e 35 sínteses primárias), com mortalidade de 55%. A sobrevida entre os métodos de fechamento não demonstrou significância estatística, mesmo após a divisão em um grupo de análise de cada técnica. Conclusão: recentes publicações destacam resultados favoráveis do abdome aberto, enfatizando a necessidade urgente de uma sistematização na assistência de pacientes com sepse abdominal complicada grave.

Active methodologies for graduation in nursing: focus on the health care of older adults.

OBJECTIVE: To describe the experience of the use of simulation as active teaching methodology in the Developmental Psychology discipline and share its impacts on the students' learning process. METHOD: Based on Active Methodologies, the students in Nursing of Universidade do Oeste Paulista - Presidente Prudente-SP developed simulated visits to older users of the Family Health Strategies. RESULTS: In accordance with the 2014 National Curriculum Guidelines and the Brazilian Unified Health System, particularities of the needs of older adults at their homes were problematized. Final considerations: Addressing the biopsychosocial needs and integrality associated with the health of older adults in simulated home visits provides a differentiated instrument in the development of skills and competence of future nurses.

Active methodologies for graduation in nursing: focus on the health care of older adults / Metodologías activas en la graduación en enfermería: enfoque en la atención al anciano / Metodologias ativas na graduação em enfermagem: um enfoque na atenção ao idoso

ABSTRACT Objective: To describe the experience of the use of simulation as active teaching methodology in the Developmental Psychology discipline and share its impacts on the students' learning process. Method: Based on Active Methodologies, the students in Nursing of Universidade do Oeste Paulista - Presidente Prudente-SP developed simulated visits to older users of the Family Health Strategies. Results: In accordance with the 2014 National Curriculum Guidelines and the Brazilian Unified Health System, particularities of the needs of older adults at their homes were problematized. Final considerations: Addressing the biopsychosocial needs and integrality associated with the health of older adults in simulated home visits provides a differentiated instrument in the development of skills and competence of future nurses.

RESUMEN Objetivo: Describir la experiencia del uso de la simulación con la metodología activa de enseñanza en la asignatura Psicología del Desarrollo y compartir repercusiones en el proceso de aprendizaje de los estudiantes. Método: Fundamentado en las Metodologías Activas, los estudiantes de enfermería de la Universidad del Oeste Paulista - Presidente Prudente-SP desarrollaron visitas domiciliares simuladas a los ancianos usuarios de las Estrategias Salud de la Familia. Resultados: en conformidad a las Directrices Curriculares Nacionales 2014 y al Sistema Único de Salud, fueron problematizadas las particularidades de las necesidades de la persona anciana en el domicilio. Consideraciones finales: Abordar las necesidades biopsicosociales y la integralidad referente a la salud de los ancianos en la visita domiciliar simulada, un instrumento diferenciado en el desarrollo de habilidades y competencia del futuro enfermero.

RESUMO Objetivo: Descrever a experiência do uso da simulação como metodologia ativa de ensino na disciplina Psicologia do Desenvolvimento e compartilhar repercussões no processo de aprendizagem dos estudantes. Método: Fundamentado nas Metodologias Ativas, os estudantes de enfermagem da Universidade do Oeste Paulista - Presidente Prudente-SP desenvolveram visitas domiciliares simuladas aos idosos usuários das Estratégias Saúde da Família. Resultados: Em conformidade às Diretrizes Curriculares Nacionais 2014 e ao Sistema Único de Saúde, foram problematizadas particularidades das necessidades da pessoa idosa no domicílio. Considerações finais: Abordar as necessidades biopsicossociais e a integralidade referente à saúde dos idosos na visita domiciliar simulada, um instrumento diferenciado no desenvolvimento de habilidades e competência do futuro enfermeiro.