Včasné zahájení léčby otevřeného břicha pomocí NPWT vede k lepším výsledkům
| Title in English | Better outcomes with early initiation of NPWT in open abdomen |
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| Authors | |
| Year of publication | 2023 |
| Type | Conference abstract |
| MU Faculty or unit | |
| Citation | |
| Description | Open abdomen (OA) is defined as a surgical option for the management of emergency patients with severe peritonitis and severe septic shock with the need for delayed bowel anastomosis, planned second look for bowel ischaemia, persistent source of peritonitis or suspected development of abdominal compartment syndrome. peritonitis or suspected development of abdominal compartment syndrome. Laparostomy is managed with temporary closure of the abdomen. One of several techniques is the use of negative pressure wound therapy (NPWT). Methods: We analysed data from a hospital information system on patients treated with NPWT. NPWT. Statistical analysis was performed using T-test at 0.05 significance level. We evaluated the duration of treatment, mortality and treatment efficacy by case mix. RESULTS: Prospective observational study of 234 patients treated with NPWT from 1 January 2013 to 30 December 2022. Abdominal sepsis was the most common indication for OA with 55.31%. The mean age of men and women was 63.40 years and 67.86 years, respectively. Gender in the age of patients with OA is a statistically significant factor at the 95% probability level. Statistical evaluation of OA assessment - the mean values in our cohort are: age 67 years, treatment time 11 days, hospitalisation time 27 days. The median IRdrg is 4.85 and the median case mix per case is 6.58. Exitus was 18.8%. Although this was a very complicated patients, almost half (49.16%) were discharged to home care after NPWT treatment. The case-mix value clearly shows the effectiveness of NPWT treatment in the open abdomen, as the time to treatment with NPWT was reduced over 10 years, and thus the length of hospital stay for high-risk patients. Discussion: Intestinal catastrophes are characterised by a significant disturbance of the internal environment due to loss of functional and anatomical capacity of the intestine. These are severe, complex and prolonged cases associated with various complications that significantly contribute to mortality and to the mortality and morbidity of 17.3-54.5% of patients who die. In addition to the primary surgery, complications, which often include persistent sepsis, must be managed. Most septic acute abdominal events with a clinical picture of abdominal catastrophe will require reoperation and elective or mandatory relaparotomy. Treatment of necrotising fasciitis and, not least, comprehensive management of extensive abdominal wall defects is essential. Once the patient is stable, it is advisable to perform definitive closure of the abdomen. If early suturing of the fascia is not possible, staged closure can be attempted at each surgical revision. of the fascia and abdominal cavity. Conclusion: NPWT is clearly an effective method in the treatment of the open abdomen according to EBM. In our cohort we demonstrated a clear benefit for the patient and the payer. |