Open Abdomen in Obese Patients: Pay Attention! New Evidences from IROA, the International Register of Open Abdomen
Authors: Ceresoli Marco , Salvetti Francesco , Kluger Yoram , Braga Marco , Viganò Jacopo , Fugazzola Paola , Sartelli Massimo , Ansaloni Luca , Catena Fausto , Coccolini Federico ,   The IROA study group, Negoi Ionut , Zese Monica , Occhionorelli Savino , Gubbiotti Francesca , Shlyapnikov Sergei , Galatioto Christian , Chiarugi Massimo , Demetrashvili Zaza , Dondossola Daniele , Ioannidis Orestis , Novelli Giuseppe , 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 Federic , Sahderov Ivan , Atanasov Boyko , Zegarra Sergio , Fattori Luca , Nigro Alice , Kirkpatrick Andrew , Parfenov Anton , Montori Giulia , Dionigi Paolo , Sugrue Michael , Dubuisson Vincent , Tochie Joel Noutakdie , Ivatury Rao 
Published: October 2019

Background

Open abdomen is the cornerstone of damage control strategies in acute care and trauma surgery. The role of BMI has not been well investigated. The aim of the study was to assess the role of BMI in determining outcomes after open abdomen.

Methods

This is an analysis of patients recorded into the International Register of Open Abdomen; patients were classified in two groups according to BMI using a cutoff of 30 kg/m2. The primary outcome was in‐hospital mortality; secondary outcomes were primary fascia closure rate, length of treatment, complication rate, entero‐atmospheric fistula rate and length of ICU stay.

Results

A total of 591 patients were enrolled from 57 centers, and obese patients were 127 (21.5%). There was no difference in mortality between the two groups; complications developed during the open treatment were higher in obese patients (63.8% vs. 53.4%, p = 0.038) while post‐closure complications rate was similar. Obese patients had a significantly longer duration of the open treatment (9.1 ± 11.5 days vs. 6.3 ± 7.5 days; p = 0,002) and lower primary fascia closure rate (75.5% vs. 89.5%; p < 0,001). No differences in fistula rate were found. There was a linear correlation between the duration of open abdomen and the BMI (Pearson's linear correlation coefficient = 0,201; p < 0,001).

Conclusions

Open abdomen in obese patients seems to be safe as in non‐obese patients with similar mortality; however, in obese patients the length of open abdomen is significantly higher with higher complication rate, longer ICU length of stay and lower primary fascia closure rate.

Trial registration number

ClinicalTrials.gov, Identifier: NCT02382770.