Abdominal Decompression after Cardiac Surgery: Outcome of 42 Patients with Abdominal Compartment Syndrome

• Published in: World journal of surgery Vol. 45; no. 4; pp. 1242 - 1251
• Main Authors: Ramser, Michaela, Glauser, Philippe M., Glass, Tracy R., Weixler, Benjamin, Grapow, Martin T. R., Hoffmann, Henry, Kirchhoff, Philipp
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.04.2021; Springer Nature B.V
• Subjects: Abdomen; Abdomen - surgery; Abdominal Cavity; Abdominal Surgery; Acidosis; Cardiac Surgery; Cardiac Surgical Procedures - adverse effects; Compartment syndrome; Compartment Syndromes; Decompression; Decompression, Surgical; Fascia; General Surgery; Health services; Heart rate; Heart surgery; Hospitals; Humans; Hypertension; Hypothermia; Intensive care units; Intra-Abdominal Hypertension - etiology; Laparotomy; Lower Body Negative Pressure; Medical treatment; Medicine; Medicine & Public Health; Mortality; Original Scientific Report; Patients; Perfusion; Resuscitation; Risk analysis; Risk factors; Surgery; Thoracic Surgery; Vascular Surgery
• ISSN: 0364-2313; 1432-2323
• DOI: 10.1007/s00268-020-05917-0

Background Up to 50% of patients in intensive care units develop intraabdominal hypertension (IAH) in the course of medical treatment. If not detected on time and treated adequately, IAH may develop into an abdominal compartment syndrome (ACS) which is associated with a high mortality rate. Patients undergoing cardiac surgery are especially prone to develop ACS due to several risk factors including intraoperative hypothermia, fluid resuscitation and acidosis. We investigated patients who developed ACS after cardiac surgery and analyzed potential risk factors, treatment and outcome. Methods From 2011 to 2016, patients with ACS after cardiac surgery requiring decompressive laparotomy were prospectively recorded. Patient characteristics, details on the cardiac surgery, mortality rate and type of treatment of the open abdomen were analyzed. Results Incidence of ACS in cardiac surgery patients was 1.0% ( n  = 42/4128), with a mortality rate of 57%. Ejection fraction, Euroscore2 as well as the perfusion time are independent risk factors for the development of ACS. The outcome of patients with ACS was independent of elective versus emergency surgery, gender, age, BMI or ASA score. In the 18 surviving patients, fascial closure was achieved in 72% after a median of 9 days. Conclusion Abdominal compartment syndrome is a rare but serious complication after cardiac surgery with a high mortality rate. Independent risk factors for ACS were identified. Negative pressure wound therapy seems to promote and allow early fascia closure of the abdomen and represents therefore a likely benefit for the patient.