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Timing of Laparotomy and Closure in Burn Patients with Abdominal Compartment Syndrome: Effects on Survival.

Timing of Laparotomy and Closure in Burn Patients with Abdominal Compartment Syndrome: Effects on Survival.
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Ramirez JI, Sen S, Palmieri TL, Greenhalgh DG,


Ramirez JI, Sen S, Palmieri TL, Greenhalgh DG, (click to view)

Ramirez JI, Sen S, Palmieri TL, Greenhalgh DG,

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Journal of the American College of Surgeons 2018 03 29() pii S1072-7515(18)30252-7
Abstract
BACKGROUND
Survival of burned patients with abdominal compartment syndrome (ACS) is uniformly reported to be poor, averaging just 16% after laparotomy. We hypothesize that better outcomes may be achieved with a strategy of immediate laparotomy and early fascial closure.

STUDY DESIGN
Patients with burn injury who were diagnosed with ACS between 2005 and 2016 were identified through a search of databases. Data was gathered from electronic medical records. Timing of laparotomy and closure were calculated for each patient. Patients were stratified into predefined groups based on timing of laparotomy, etiology of ACS, patient age, and timing of abdominal closure. Survival was calculated and compared (SD-standard deviation).

RESULTS
Forty-six patients with burn injury and ACS were identified. ACS developed during initial resuscitation in 27 patients, during perioperative resuscitation in five, and during an episode of sepsis in 13. Overall survival was 56%. The mean time to laparotomy from diagnosis of ACS was 1 hour 8 minutes (SD 59 minutes). In patients who developed ACS during initial resuscitation, the mean time to laparotomy from hospital admission was 13 hours (SD 7 hours). Survival in this group was 70%, whereas survival in patients treated for ACS later in their hospital course was 33% (p = 0.03). Survival among patients whose laparotomy was closed within 48 hours was 100%, whereas survival among patients whose laparotomy was not closed within 48 hours was 48% (p = 0.01).

CONCLUSIONS
Immediate laparotomy resulted in much higher survival rates than previously reported in burned patients with ACS. Survival was higher when ACS was diagnosed during initial resuscitation. Fascial closure within 48 hours was associated with improved survival compared with later fascial closure.

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