To Close or Not To Close, That Is One of the Questions? Perceptions of Trauma Association of Canada Surgical Members on the Management of the Open Abdomen

BACKGROUND: The optimal abdominal closure in critically ill surgical/trauma patients remains controversial with a wide variety of commonly employed techniques. We sought to evaluate clinical equipoise by surveying Canadian surgeons regarding the use of temporary abdominal closure strategies in damage control and emergency situations. METHODS: A structured mixed-mode (Website and paper), scenario-based questionnaire was developed by members of the Canadian Trauma Trials Collaborative and directed to surgical members of the Trauma Association of Canada (TAC). RESULTS: The overall response rate was 84% (86 out of 102). In resuscitated hemodynamically stable trauma patients, 42% (29 out of 69) of respondents elected to primarily close an "extremely tight" abdominal cavity while only 23% (16 out of 70) would primarily close the same patient when physiologic exhaustion (Damage control (DC) conditions-hypothermia, acidosis, and coagulopathy) supervened. Although the majority reported preference for temporizing abdominal closures 73% (51 out of 70) non-DC, 75% (52 out of 69) DC when the fascia was physically impossible to close; the reported primary use of mesh in these situations was quite high 24.6% (17 out of 69) non-DC, 24% (16 out of 69) DC, including a reported 7% (5 out of 69) nonabsorbable mesh usage in a contaminated octogenarian abdomen. CONCLUSION: Reported opinions suggest an overall appreciation for markers of "Damage Control," although clinical equipoise exists regarding the preferred technique and a frequent early use of mesh. These results highlight the necessity for further research but suggest challenges in defining a common standard for multicenter trials.