S. Ross1, P. Fischer1, K. Dahey1, C. Huntington1, T. Cox1, L. Blair1, B. T. Heniford1, V. Augenstein1, A. B. Christmas1, R. Sing1 1Carolinas Medical Center,Charlotte, NC, USA
Introduction:
Abdominal compartment syndrome (ACS) can lead to multisystem organ dysfunction, often requiring surgical decompression despite early medical management. To date, no national, multicenter data exists regarding patient treatment, outcomes, and risk factors for mortality in ACS. Our purpose was to quantify rates of adverse outcomes in ACS and identify predictors of mortality.
Methods:
The National Inpatient Sample database was queried from 2006-2011 for all traumatic and non-traumatic ICD-9 diagnoses of ACS. Primary outcomes were medical and procedural complications and in-hospital mortality. Standard statistical tests were applied, and stepwise logistic regression (SLR) was used to identify independent predictors of mortality.
Results:
There were 2,657 patients with ACS: 2,077 from non-traumatic and 580 from traumatic etiologies. On average, patients were middle aged (56.4 ± 17.7 years), male (63.0%), had few comorbidities (Charlson Comorbidity Index 1.8 ± 2.2). Concomitant abdominal operations were performed in 63.4% of patients including exploration and/or resection. Causes of complications were medical in 95.1% and surgical in 52.1%, with overall mortality rates high at 50.7%. Patients with traumatic ACS had lower rates of medical complications (77.8%vs100%;p<0.001), but similar surgical complication (53.1%vs53.8%; p>0.05) and mortality rates (48.8%vs51.5%; p>0.05). Significant univariate analysis results by mortality are reported in the table. On SLR, predictors of mortality (odds ratio): emergent admission (1.5), teaching hospital (1.8), increasing age (1.03/year). Protective factors by SLR were: elective admission (0.66), surviving to tracheostomy (0.32), gastrostomy (0.36), and ventral hernia repair (0.13); p<0.001 for all.
Conclusion:
Abdominal compartment syndrome carries significant morbidity with over half of cases resulting in death. Patients who survive to undergo subsequent procedures are much more likely to survive their hospital stay. However, predictors of death in ACS include increasing age, emergent presentation, and teaching hospital admission. Consideration of more aggressive treatment of suspected ACS at an earlier stage for patients with these known high risk predictors may aide in saving lives.
