Selection of patients for open abdomen (OA) treatment in severe acute pancreatitis (SAP) is challenging. Treatment related morbidity and risk of adverse events are high; however, refractory abdominal compartment syndrome (ACS) is potentially lethal. Factors influencing the decision to initiate OA treatment are clinically important. We aimed to study these factors to help understand what influences the selection of patients for OA treatment in SAP. A single center study of patients with SAP that underwent OA treatment compared with conservatively treated matched controls. Within study period, 47 patients treated with OA were matched in a 1:1 fashion with conservatively treated control patients. Urinary output under 20 ml/h (OR 5.0 95% CI 1.8-13.7) and ACS (OR 4.6 95% CI 1.4-15.2) independently associated with OA treatment. Patients with OA treatment had significantly more often visceral ischemia (34%) than controls (6%), P = 0.002. Mortality among patients with visceral ischemia was 63%. Clinically meaningful parameters predicting developing ischemia were not found. OA treatment associated with higher overall 90-day mortality rate (43% vs 17%, P = 0.012) and increased need for necrosectomy (55% vs 21%, P = 0.001). Delayed primary fascial closure was achieved in 33 (97%) patients that survived past OA treatment. Decreased urine output and ACS were independently associated with the choice of OA treatment in patients with SAP. Underlying visceral ischemia was strikingly common in patients undergoing OA treatment, but predicting ischemia in these patients seems difficult.

中文翻译：

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谁会受益于严重急性胰腺炎开腹？——一项匹配的病例对照研究

在严重急性胰腺炎 (SAP) 中选择开腹 (OA) 治疗的患者具有挑战性。与治疗相关的发病率和不良事件风险很高；然而，难治性腹腔室综合征 (ACS) 可能是致命的。影响开始 OA 治疗决定的因素在临床上很重要。我们旨在研究这些因素，以帮助了解是什么影响了 SAP 中 OA 治疗患者的选择。对接受 OA 治疗的 SAP 患者与保守治疗的匹配对照进行比较的单中心研究。在研究期间，47 名接受 OA 治疗的患者与接受保守治疗的对照患者以 1:1 的方式配对。尿量低于 20 ml/h (OR 5.0 95% CI 1.8-13.7) 和 ACS (OR 4.6 95% CI 1.4-15.2) 与 OA 治疗独立相关。接受 OA 治疗的患者发生内脏缺血 (34%) 的频率明显高于对照组 (6%)，P = 0.002。内脏缺血患者的死亡率为 63%。没有发现具有临床意义的预测发生缺血的参数。OA 治疗与较高的 90 天总死亡率（43% 对 17%，P = 0.012）和对坏死切除术的需求增加（55% 对 21%，P = 0.001）相关。33 名（97%）在 OA 治疗后幸存下来的患者实现了延迟原发性筋膜闭合。尿量减少和 ACS 与 SAP 患者选择 OA 治疗独立相关。在接受 OA 治疗的患者中，潜在的内脏缺血非常常见，但预测这些患者的缺血似乎很困难。内脏缺血患者的死亡率为 63%。没有发现具有临床意义的预测发生缺血的参数。OA 治疗与较高的 90 天总死亡率（43% 对 17%，P = 0.012）和对坏死切除术的需求增加（55% 对 21%，P = 0.001）相关。33 名（97%）在 OA 治疗后幸存下来的患者实现了延迟原发性筋膜闭合。尿量减少和 ACS 与 SAP 患者选择 OA 治疗独立相关。在接受 OA 治疗的患者中，潜在的内脏缺血非常常见，但预测这些患者的缺血似乎很困难。内脏缺血患者的死亡率为 63%。没有发现具有临床意义的预测发生缺血的参数。OA 治疗与较高的 90 天总死亡率（43% 对 17%，P = 0.012）和对坏死切除术的需求增加（55% 对 21%，P = 0.001）相关。33 名（97%）在 OA 治疗后幸存下来的患者实现了延迟原发性筋膜闭合。尿量减少和 ACS 与 SAP 患者选择 OA 治疗独立相关。在接受 OA 治疗的患者中，潜在的内脏缺血非常常见，但预测这些患者的缺血似乎很困难。012) 和对坏死切除术的需求增加（55% 对 21%，P = 0.001）。33 名（97%）在 OA 治疗后幸存下来的患者实现了延迟原发性筋膜闭合。尿量减少和 ACS 与 SAP 患者选择 OA 治疗独立相关。在接受 OA 治疗的患者中，潜在的内脏缺血非常常见，但预测这些患者的缺血似乎很困难。012) 和对坏死切除术的需求增加（55% 对 21%，P = 0.001）。33 名（97%）在 OA 治疗后幸存下来的患者实现了延迟原发性筋膜闭合。尿量减少和 ACS 与 SAP 患者选择 OA 治疗独立相关。在接受 OA 治疗的患者中，潜在的内脏缺血非常常见，但预测这些患者的缺血似乎很困难。