Patients with an Open Abdomen in Asian, American and European Continents: A Comparative Analysis from the International Register of Open Abdomen (IROA)
Authors: Sibilla Maria Grazia , Cremonini Camilla , Portinari Mattia , Carcoforo Paolo , Tartaglia Dario , Cicuttin Enrico , Musetti Serena , Strambi Silvia , Sartelli Massimo , Radica Margherita Koleva , Catena Fausto , Chiarugi Massimo , Coccolini Federico ,   IROA Study Group, Montori Giulia , Salvetti Fracensco , Negoi Ionut , Zese Monica , Occhionorelli Savino , Shlyapnikov Sergei , Sugrue Michael , Demetrashvili Zaza , Dondossola Daniele , Ioannidis Orestis , Novelli Giuseppe , Frattini Cristina , Nacoti Mirco , Khor Desmond , Inaba Kenji , Demetriades Demetrios , Kaussen Torsten , Jusoh Asri Che , Ghannam Wagih , Sakakushev Boris , Guetta Ohad , Dogjani Agron , Costa Stefano , Singh Sandeep , Damaskos Dimitrios , Isik Arda , Yuan Kuo‐Ching , Trotta Francesco , Rausei Stefano , Martinez‐Perez Aleix , Bellanova Giovanni , Fonseca Vinicius Cordeiro , Hernández Fernando , Marinis Athanasios , Fernandes Wellington , Quiodettis Martha , Bala Miklosh , Vereczkei Andras , Curado Rafael , Fraga Gustavo Pereira , Pereira Bruno M. , Gachabayov Mahir , Chagerben Guillermo Perez , Arellano Miguel Leon , Ozyazici Sefa , Costa Gianluca , Tezcaner Tugan , Porta Matteo , Li Yousheng , Karateke Faruk , Manatakis Dimitrios , Mariani Federico , Lora Federico , Sahderov Ivan , Atanasov Boyko , Zegarra Sergio , Fattori Luca , Ivatury Rao , Xiao Jimmy , Ben‐Ishay Offir , Zharikov Andrey , Dubuisson Vincent 
Published: November 2022

Background

International register of open abdomen (IROA) enrolls patients from several centers in American, European, and Asiatic continent. The aim of our study is to compare the characteristics, management and clinical outcome of adult patients treated with OA in the three continents.

Material and methods

A prospective analysis of adult patients enrolled in the international register of open abdomen (IROA). Trial registration: NCT02382770.

Results

1183 patients were enrolled from American, European and Asiatic Continent. Median age was 63 years (IQR 49–74) and was higher in the European continent (65 years, p < 0.001); 57% were male. The main indication for OA was peritonitis (50.6%) followed by trauma (15.4%) and vascular emergency (13.5%) with differences among the continents (p < 0.001). Commercial NPWT was preferred in America and Europe (77.4% and 52.3% of cases) while Barker vacuum pack (48.2%) was the preferred temporary abdominal closure technique in Asia (p < 0.001). Definitive abdominal closure was achieved in 82.3% of cases in America (fascial closure in 90.2% of cases) and in 56.4% of cases in Asia (p < 0.001). Prosthesis were mostly used in Europe (17.3%, p < 0.001). The overall entero‐atmospheric fistula rate 2.5%. Median open abdomen duration was 4 days (IQR 2–7). The overall intensive care unit and hospital length‐of‐stay were, respectively, 8 and 11 days (no differences between continents). The overall morbidity and mortality rates for America, Europe, and Asia were, respectively, 75.8%, 75.3%, 91.8% (p = 0.001) and 31.9%, 51.6%, 56.9% (p < 0.001).

Conclusion

There is no uniformity in OA management in the different continents. Heterogeneous adherence to international guidelines application is evident. Different temporary abdominal closure techniques in relation to indications led to different outcomes across the continents. Adherence to guidelines, combined with more consistent data, will ultimately allow to improving knowledge and outcome.