Revisiting abdominal closure in mesenteric ischemia: is there an association with outcome?

Purpose Current guidelines advocate liberal use of delayed abdominal closure in patients with acute mesenteric ischemia (AMI) undergoing laparotomy. Few studies have systematically examined this practice. The goal of this study was to evaluate the effect of delayed abdominal closure on postoperative...

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Bibliographic Details
Published in:European journal of trauma and emergency surgery (Munich : 2007) 2023-10, Vol.49 (5), p.2017-2024
Main Authors: Proaño-Zamudio, Jefferson A., Argandykov, Dias, Renne, Angela, Gebran, Anthony, Dorken-Gallastegi, Ander, Paranjape, Charudutt N., Kaafarani, Haytham M. A., King, David R., Velmahos, George C., Hwabejire, John O.
Format: Article
Language:English
Subjects:
Abdomen
Colorectal surgery
Critical Care Medicine
Emergency Medicine
Intensive
Ischemia
Laparotomy
Medicine
Medicine & Public Health
Mortality
Original Article
Postoperative period
Sports Medicine
Surgery
Surgical Orthopedics
Surgical outcomes
Traumatic Surgery
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Summary:Purpose Current guidelines advocate liberal use of delayed abdominal closure in patients with acute mesenteric ischemia (AMI) undergoing laparotomy. Few studies have systematically examined this practice. The goal of this study was to evaluate the effect of delayed abdominal closure on postoperative morbidity and mortality in patients with AMI. Methods We performed a retrospective cohort study of the ACS-NSQIP 2013–2017 registry. We included patients with a diagnosis of AMI undergoing emergency laparotomy. Patients were divided into two groups based on the type of abdominal closure: (1) delayed fascial closure (DFC) when no layers of the abdominal wall were closed and (2) immediate fascial closure (IFC) if deep layers or all layers of the abdominal wall were closed. Propensity score matching was performed based on comorbidities, pre-operative, and operative characteristics. Univariable analysis was performed on the matched sample. Results The propensity-matched cohort consisted of 1520 patients equally divided into the DFC and IFC groups. The median (IQR) age was 68 (59–77), and 836 (55.0%) were female. Compared to IFC, the DFC group showed increased in-hospital mortality (38.9% vs. 31.6%, p  = 0.002), 30-day mortality (42.4% vs. 36.3%, p  = 0.012), and increased risk of respiratory failure (59.5% vs. 31.2%, p  
ISSN:1863-9933
1863-9941
DOI:10.1007/s00068-022-02199-0