A prediction model for fascial closure in the open abdomen

Cristaudo, Adam, Hitos, Kerry, Gunnarsson, Ronny, and De Costa, Alan (2018) A prediction model for fascial closure in the open abdomen. In: [Presented at SWAN 2018: Trauma, Critical Care & Emergency Surgery Conference]. From: SWAN 2018: Trauma, Critical Care & Emergency Surgery Conference, 27-28 July 2018, Sydney, NSW, Australia.

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Abstract

Objective/Introduction: The use of the open abdomen (OA) technique is an important approach for managing intra-abdominal catastrophes. However, delays in definitive fascial closure (DFC) are associated with a high incidence of complications and poor outcomes. The aim of this study is to develop a multivariate prediction model for DFC in patients being managed with an OA.

Methods: A multicentre observational study was performed involving all patients managed with an OA admitted to Cairns, Townsville and Royal Brisbane & Women's Hospitals from 2000 to 2016. Prognostic factors were based on a recent systematic review. Statistical analysis was performed using multivariate logistic regression with 28 prognostic factors for DFC.

Results: In total, 312 patients were managed with an OA. DFC occurred in 219 patients (70%). Median DFC time was 2 days (interquartile range: 3 days). Significant prognostic factors included Acute Physiology and Chronic Health Evaluation III score (odds ratio (OR): 0.97; 95% confidence interval (CI): 0.96, 0.98), respiratory failure (OR: 0.38; 95% CI: 0.16, 0.82), peritoneal contamination (OR: 0.22; 95% CI: 0.05, 0.98), total procedures (OR: 0.71; 95% CI: 0.63, 0.81) and year (OR: 1.1; 95% CI: 1.0, 1.2). A multivariate prediction model was developed to demonstrate a patient's likelihood of DFC (receiver operator curve area under curve = 0.88, 95% CI: 0.83, 0.92)

Conclusion: Predictor variables were identified using clinical knowledge and statistical reasoning to develop a multivariate prediction model for DFC in patients being managed with an OA. External validation of this model will allow for this to be readily used in clinical practice.

Item ID: 57110
Item Type: Conference Item (Abstract / Summary)
Date Deposited: 25 Mar 2019 02:01
FoR Codes: 11 MEDICAL AND HEALTH SCIENCES > 1103 Clinical Sciences > 110323 Surgery @ 100%
SEO Codes: 92 HEALTH > 9201 Clinical Health (Organs, Diseases and Abnormal Conditions) > 920118 Surgical Methods and Procedures @ 100%
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