The use of a visceral protective layer prevents fistula development in open abdomen therapy - results from the ehs open abdomen registry

Abstract Purpose Enteroatmospheric fistula (EAF) development is a severe complication of open abdomen therapy (OAT), thus this study yields to evaluate the protective effect of a visceral protective layer (VPL) based on registry data. Material and Methods All cases from the EHS Open Abdomen Registry since its establishment on May 1st, 2015, and Dec 4th, 2022, were enrolled in this study. Descriptive and comparative statistics were conducted before and after propensity score matching to reduce confounding effects. In addition, a logistic regression analysis has been used to reveal determining factors of EAF development. Results Overall 1,009 cases have been entered into the EHS Open Abdomen Registry. The main indications for OA were peritonitis (36.6%), burst abdomen/ACS (29.5%), and trauma (8.8%). The overall mortality rate was 27.9% (n=282). VPL was used in 561 cases (55.6%), negative-pressure wound therapy in 332 patients (31.9%), and fascial traction in 316 cases (31.3%). The OAT duration was 20.8±37.0 days. 71 fistulas (7.0%) were reported. The fistula rates differed significantly depending on the use of a VPL (noVPL 16.2% vs. VPL 6.1%, p=.00, matched). The effect of VPL on EAF yielded an OR of 0.36 (CI:0.21–0.60, p=.000) in the overall population. That effect remained in the matched collective with an OR of 0.34 (CI: 0.17–0.68, p=.002), which yielded a 66% relative risk reduction. Conclusion The use of VPL in OAT showed a significantly reduced incidence of EAF. In order to reduce morbidity and mortality associated with the open abdomen procedure, its application is therefore considered mandatory.