Severe abdominal adverse events following open abdomen: a multicenter retrospective observational study

Background: Open abdomen (OA) is a surgical strategy used for conditions such as intra-abdominal organ injury, abdominal compartment syndrome, and abdominal sepsis. However, some patients experience severe abdominal adverse events after OA, which can lead to prolonged hospital stays and the failure of primary fascial closure. This study aimed to identify practical predictors of severe abdominal adverse events in patients treated with OA. Methods: This post hoc analysis used data from the nationwide, multicenter retrospective OPTITAC study, which included adult patients (≥18 years) who had undergone laparotomy requiring OA between 2010 and 2022 across 12 hospitals. Severe abdominal adverse events after OA included anastomotic leakage, enteroatmospheric fistula, pancreatic and biliary fistula, and abdominal fascia dehiscence after closure. Predictive factors from preoperative, intraoperative, and postoperative phases were analyzed using generalized estimating equations to account for institutional and regional differences in the management of patients with OA. Results: Of the 302 patients included in this study, 74 (24.5%) experienced severe abdominal adverse events after OA. Higher body mass index (BMI) and receiving <2 l fluid resuscitation within 6 hours before laparotomy were associated with an increased incidence of severe abdominal adverse events odds ratios (ORs): 1.06 (1.01–1.18) and 2.39 (1.60–3.57), respectively). In contrast, greater preoperative fluid volume was associated with a decreased incidence of severe abdominal adverse events [OR: 0.73 (0.59–0.91) per 1 l increase. In addition, a fluid balance <2 l within 24 hours after surgery was associated with abdominal adverse events in patients with nonelevated postoperative serum lactate levels. Conclusions: Low preoperative fluid volume and high BMI were associated with an increased incidence of severe abdominal adverse events in patients undergoing OA. These findings underscore the importance of fluid resuscitation before surgery in patients undergoing OA.