Abstract：
OBJECTIVE: Open abdomen therapy (OAT) is commonly used to prevent or treat abdominal compartment syndrome (ACS) in patients with ruptured abdominal aortic aneurysms (rAAAs). This study aimed to evaluate the incidence, treatment, and outcomes of OAT after rAAA from 2006 to 2021. Investigating data on resuscitation fluid, weight gain, and cumulative fluid balance could provide a more systematic approach to determining the timing of safe abdominal closure.
METHODS: This was a single centre observational cohort study. The study included all patients treated for rAAA followed by OAT from October 2006 to December 2021.
RESULTS: Seventy-two of the 244 patients who underwent surgery for rAAA received OAT. The mean age was 72 ± 7.85 years, and most were male (n = 61, 85%). The most frequent comorbidities were cardiac disease (n = 31, 43%) and hypertension (n = 31, 43%). Fifty-two patients (72%) received prophylactic OAT, and 20 received OAT for ACS (28%). There was a 25% mortality rate in the prophylactic OAT group compared with the 50% mortality in those who received OAT for ACS (p = .042). The 58 (81%) patients who survived until closure had a median of 12 (interquartile range [IQR] 9, 16.5) days of OAT and 5 (IQR 4, 7) dressing changes. There was one case of colocutaneous fistula and two cases of graft infection. All 58 patients underwent successful abdominal closure, with 55 (95%) undergoing delayed primary closure. In hospital survival was 85%. Treatment trends over time showed the increased use of prophylactic OAT (p ≤ .001) and fewer ACS cases (p = .03) assessed by Fisher\'s exact test. In multivariable regression analysis fluid overload and weight reduction predicted 26% of variability in time to closure.
CONCLUSIONS: Prophylactic OAT after rAAA can be performed safely, with a high rate of delayed primary closure even after long term treatment.
METHODS: This was a single centre observational cohort study. The study included all patients treated for rAAA followed by OAT from October 2006 to December 2021.
RESULTS: Seventy-two of the 244 patients who underwent surgery for rAAA received OAT. The mean age was 72 ± 7.85 years, and most were male (n = 61, 85%). The most frequent comorbidities were cardiac disease (n = 31, 43%) and hypertension (n = 31, 43%). Fifty-two patients (72%) received prophylactic OAT, and 20 received OAT for ACS (28%). There was a 25% mortality rate in the prophylactic OAT group compared with the 50% mortality in those who received OAT for ACS (p = .042). The 58 (81%) patients who survived until closure had a median of 12 (interquartile range [IQR] 9, 16.5) days of OAT and 5 (IQR 4, 7) dressing changes. There was one case of colocutaneous fistula and two cases of graft infection. All 58 patients underwent successful abdominal closure, with 55 (95%) undergoing delayed primary closure. In hospital survival was 85%. Treatment trends over time showed the increased use of prophylactic OAT (p ≤ .001) and fewer ACS cases (p = .03) assessed by Fisher\'s exact test. In multivariable regression analysis fluid overload and weight reduction predicted 26% of variability in time to closure.
CONCLUSIONS: Prophylactic OAT after rAAA can be performed safely, with a high rate of delayed primary closure even after long term treatment.
摘要：
目的：开腹治疗（OAT）通常用于预防或治疗破裂腹主动脉瘤（rAAAs）患者的腹腔室综合征（ACS）。本研究旨在评估发病率，治疗,以及2006年至2021年rAAA后OAT的结果。调查复苏液的数据，体重增加,和累积液体平衡可以提供更系统的方法来确定安全的腹部闭合时间。
方法：这是一项单中心观察性队列研究。该研究包括2006年10月至2021年12月接受rAAA和OAT治疗的所有患者。
结果：244例接受rAAA手术的患者中有72例接受了OAT。平均年龄72±7.85岁,大多数是男性（n=61，85％）。最常见的合并症是心脏病（n=31，43％）和高血压（n=31，43％）。52例患者（72%）接受预防性OAT，20人接受了ACS的OAT（28％）。预防性OAT组的死亡率为25％，而接受OAT治疗的ACS患者的死亡率为50％（p=.042）。存活至关闭的58例（81％）患者的OAT中位天数为12天（四分位距[IQR]9，16.5天），换药天数为5天（IQR4，7）。共有1例皮肤瘘和2例移植物感染。所有58例患者均成功进行了腹部闭合，55（95％）进行延迟初次闭合。医院生存率为85%。随着时间的推移，治疗趋势显示，通过Fisher精确检验评估，预防性OAT的使用增加（p≤.001），ACS病例减少（p=.03）。在多变量回归分析中，液体超负荷和体重减轻可预测闭合时间的变异性为26％。
结论：rAAA后的预防性OAT可以安全地进行，即使在长期治疗后，延迟的原发性闭合率也很高。
方法：这是一项单中心观察性队列研究。该研究包括2006年10月至2021年12月接受rAAA和OAT治疗的所有患者。
结果：244例接受rAAA手术的患者中有72例接受了OAT。平均年龄72±7.85岁,大多数是男性（n=61，85％）。最常见的合并症是心脏病（n=31，43％）和高血压（n=31，43％）。52例患者（72%）接受预防性OAT，20人接受了ACS的OAT（28％）。预防性OAT组的死亡率为25％，而接受OAT治疗的ACS患者的死亡率为50％（p=.042）。存活至关闭的58例（81％）患者的OAT中位天数为12天（四分位距[IQR]9，16.5天），换药天数为5天（IQR4，7）。共有1例皮肤瘘和2例移植物感染。所有58例患者均成功进行了腹部闭合，55（95％）进行延迟初次闭合。医院生存率为85%。随着时间的推移，治疗趋势显示，通过Fisher精确检验评估，预防性OAT的使用增加（p≤.001），ACS病例减少（p=.03）。在多变量回归分析中，液体超负荷和体重减轻可预测闭合时间的变异性为26％。
结论：rAAA后的预防性OAT可以安全地进行，即使在长期治疗后，延迟的原发性闭合率也很高。
