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VAC Abdominal Dressing – a retrospective
study in the treatment of the open
abdomen following secondary peritonitis
and abdominal compartment syndrom
Thomas Wild, MD
Antwerp 2007
Current treatment of Open
Abdomen
No standard conventional
treatment
Based on surgeon’s preference
To date no large studies
comparing outcome
Methods
5 surgical departments in Austria
Retrospective analysis 2001-2006
Patients with secondary peritonitis
Treatment with (decided by treating
physician)
Open packing (OP)
Classic VAC (CV)
VAC Abdominal dressing (AD)
Traditional Methods
Classic V.A.C.
Abdominal Dressing
Outcome parameters
Outcome parameters
APACHE II score
Duration of open abdomen
LOS in ICU
Nursing requirements
Mortality
Patient demographics
OP (SD) CV (SD) AD (SD) p-value*
Patient
62 102 75
number (n)
Mean Age 60.3 62.8 61.8
p=0.62
(years) (15.0) (13.9) (15.0)
26.5 26.2 29.1
Mean BMI p=0.13
(7.6) (5.6) (8.5)
Mean Weight 79.6 76.3 82.9
p=0.21
(kg) (23.0) (19.2) (26.4)
Mean Apache 18.9 16.8 19.3
p<0.002
II (8.1) (8.0) (9.4)
* Kruskal-Wallis test, SD = standard deviation
Primary operation
Reason Small Large
Stomach Pancreas Trauma Absces Ascites Ileus Acute
bowel bowel
Therapy
OP 5 8 20 3 1 2 1 2 20
CV 11 11 35 8 0 4 0 5 28
AD 7 15 20 4 0 2 0 4 23
Total 23 34 75 15 1 8 1 11 71
Therapy at different
hospitals
3,5
3
2,5
therapy
2
1,5
1
0,5
0
Hospital I Hospital II Hospital III Hospital IV Hospital V
Age distribution
100
90
80
68,0
70
72,5
60 68,0
age
60,0
50 57,5
40
30
20
10
0
Hospital I Hospital II Hospital III Hospital IV Hospital V
APACHE II
50 p=0.13*
p<0.001* p=0.08*
40
APACHE II
30
20
10
0
AD CV OP
therapy
APACHE II score
25
30 26
26
25 17
22 18,5 26
15
20
14,5 16,5
17
Median APACHE II 15
14
10
5 AD
0 CV
Therapy
Hospital I OP
Hospital II
Hospital III
Hospital IV
Mortality
100%
p<0.001*
90% p<0.001*
ns
80% 76%
70%
60%
mortality
50%
37% 36%
40%
30%
20%
10%
0%
OP CV AD
therapy
OP vs CV :p<0.001* ; OP vs AD : p<0.001* ; CV vs AD : ns*
Hospital I
100%
90%
p=0,0012
80%
70%
60%
mortality
50%
40%
30%
20%
10%
0%
OP CV AD
therapy
Mortality differences
between hospitals
Days in ICU
40 37,6 36,4
35
30
Days (mean)
30
25 OP
20 CV
15 AD
10
5
0
ICU stay
p= 0.25, Kruskal-Wallis test
ICU stay different between
hospitals
120
113
100
80
62
47 68
Median dICU 60
30
40 22,5
36 10
15,5 17
20
26,5
9 AD
0 15 24,5
CV
Therapy
Hospital
Hospital OP
I Hospital
II Hospital
III Hospital
IV
V
Days to abdominal
closure
45
P=ns
40
35
30
Days
OP
25
CV
20
AD
15 41.4 21.9 33.3
10 ±91.4 ±17.5 ±40.4
5
0
Abdominal Closure
Treatment Pathway
Time Acute Abdomen Monitoring
Infection and/or increased IAP >25mmHg, CT,
Defense Necrosis, Fibrin,
intra-abdominal pressure Granulation tissue CRP,
Emergency Leukocytes, Fibrinogen
2nd or 3rd Clotting
postoperative
day Lavage & Debridement
Closure not Closure
possible possible
VAC application and Immediate abdominal IAP < 15 mmHg
Necrosis, Fibrin,
dynamic sutures closure Granulation tissue,
CRP, Leukocytes,
Closure not Fibrinogen, Clotting
possible
every 2nd -3rd day VAC-dressing change, Lavage, Dynamic sutures Necrosis, Fibrin,
Granulation tissue
(Mo-Wed-Fri.)
CRP, Leukocytes,
Closure not Closure Fibrinogen
possible possible Exudate amount
IAP < 15 mmHg
Abdominal wall closure Nutrition–Albumin,
Protein, Pre-albumin,
Transferrin,
Kidney function,
80% Granulation tissue, Creatinin, BUN
Wound bed preparation and/or CRP (<5), Leukocytes
from 4th Day no Infection, less than 50
secondary wound closure ml Exudate in 48 hours (<12.000), Fibrinogen
Exudate amount 100-
200 ml/day clear liquid
Perspective
Prospective Study is started now
Please sign in the regestry!
thomas.wild@meduniwien.ac.at
