Physiologic Factors Leading to Temporary Abdominal Closure In EGS Patients Identified

Preoperative coagulopathy, vasopressor use and incomplete source control at index operation are the clinical features most likely to lead to a surgeon performing temporary abdominal closure (TAC) among emergency general surgery (EGS) patients, according to new research.

“There is a lack of consensus on the indications for use of second-look laparotomy, specifically in EGS,” said Rebecca Zhu, MD, a fourth-year general surgery resident at Mayo Clinic in Rochester, Minn.

The aim of the study was to determine which clinical factors are most predictive of a surgeon’s decision to use TAC, specifically in patients undergoing EGS (quick shot 20).

The multi-institutional, prospective observational study looked at a total of 766 adult patients who underwent exploratory laparotomy for abdominal sepsis at 21 centers. Of these patients, 44% were managed with TAC, and they were more likely to have higher ASA physical status and Charlson Comorbidity Index scores, lactate levels, international normalized ratios (INRs), vasopressor use, and mortality.

Upon conducing multivariable analysis, the team found the need for preoperative vasopressors was the clinical factor most predictive of being managed with an open abdomen. Sepsis/severe sepsis also was predictive of open abdomen procedures.

Achievement of source control at time of index operation, as well as a complex interaction term consisting of an ASA physical status class no more than III, source control completion and an INR test no more than 1.3 were predictive of not being managed with an open abdomen.

“The decision to manage EGS patients with an open abdomen seems to be primarily driven by patient factors and, really, by [patients’] physiology,” Dr. Zhu said. “This study serves as a springboard for future investigation to better clarify what are the indications for using an open abdomen technique, specifically in this population.”

Dr. Zhu also noted that while the study indicates that EGS patients who are managed with an open abdomen have higher rates of mortality, additional research is needed to determine whether this is due to patient factors or the use of TAC itself.

This article is from the March 2022 print issue.