Management of the open abdomen during the global war on terror

Gordon M. Riha, Laszlo N. Kiraly, Brian S. Diggs, S. David Cho, Loic J. Fabricant, Stephen F. Flaherty, Reed Kuehn, Samantha J. Underwood, Martin A. Schreiber

    Research output: Contribution to journalArticle

    8 Scopus citations

    Abstract

    Objective: To evaluate factors that are predictive of delayed abdominal closure in patients injured during military conflict. Design, Setting, and Patients: Seventy-one patients managed with an open abdomen were identified from records at Landstuhl Regional Medical Center from 2005 and 2006. Follow-up data were available from Walter Reed Army Medical Center. Records were reviewed through all echelons of care. Ordinal logistic regression was used to predict delayed abdominal closure. Results: Patients sustained injury from blunt (n=2), penetrating (n=30), and blast (n=39) mechanisms. The median Injury Severity Score was 25 (interquartile range, 17-34). Abdominal injury was observed in 85% of patients, and 48% underwent a massive transfusion. The median time to transfer to the United States was 5.3 days (interquartile range, 4.3-6.8 days). Abdomens were definitively closed downrange (11%), at Landstuhl Regional Medical Center (33%), or at Walter Reed Army Medical Center (56%). The median time until abdominal closure was 13 days (interquartile range, 4-40 days) in 2005 compared with 4 days (interquartile range, 1-14.5 days) in 2006 (P=.02). The multivariate model identified massive transfusion (odds ratio, 3.9), presence of complications (odds ratio, 5.1), and an injury date in 2005 (odds ratio, 3.4) as independently predictive variables for later abdominal closure. Conclusions: Massive transfusion, occurrence of complications, and earlier injury date were predictive of delayed abdominal closure in casualties managed with an open abdomen. These data suggest an evolving approach to the management of severely injured combat casualties that involves earlier abdominal closure.

    Original languageEnglish (US)
    Pages (from-to)59-64
    Number of pages6
    JournalArchives of Surgery
    Volume148
    Issue number1
    DOIs
    StatePublished - Jan 2013

    ASJC Scopus subject areas

    • Surgery

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  • Cite this

    Riha, G. M., Kiraly, L. N., Diggs, B. S., Cho, S. D., Fabricant, L. J., Flaherty, S. F., Kuehn, R., Underwood, S. J., & Schreiber, M. A. (2013). Management of the open abdomen during the global war on terror. Archives of Surgery, 148(1), 59-64. https://doi.org/10.1001/2013.jamasurg.4