Temporary abdominal closure techniques for open abdomen management in trauma patients
Importance: Open abdomen with temporary abdominal closure has become an essential part of trauma surgery; however, it is also linked with high morbidity and mortality. The choice of the technique for abdominal closure is a crucial determinant of the success of the open abdomen procedure. Objective: The aim of this meta-analysis was to compare various temporary abdominal closure techniques—negative pressure wound therapy with or without continuous fascial traction, skin tension, meshes, Bogota bags, and Wittman patches, were grouped using two classification criteria: via method of closure i.e. skin-only closure vs. patch closure vs. vacuum closure; and via dynamics of treatment i.e. static therapy (ST) vs. dynamic therapy (DT)—in terms of their in-hospital mortality rates, definitive fascial closure rates (DFC), and incidences of intra-abdominal complications (enteric fistula, ventral hernia, and peritoneal abscess). Data Sources: The studies included in this meta-analysis were sourced from PubMed, Embase, the Cochrane Central Register of Controlled Trials, and Clinicaltrials.gov. Study Selection: Studies that were included were of various designs but focused exclusively on trauma patients and reported at least one of the three clinical outcomes mentioned above. Data Extraction and Synthesis: The extracted data included first author names, years of publication, baseline study characteristics (sample size, mean/median age, etc.), and clinical endpoints. The meta-analysis module in R was used for data synthesis. Forest plots were created to visualize the data; weighted proportions and 95% confidence intervals (CI) were calculated to compare the data. Main Outcome(s) and Measure(s): The main outcomes measured were the in-hospital mortality rates, definitive fascial closure rates, and the incidences of intra-abdominal complications for each abdominal closure techniques. Results: We identified 1,065 studies; 37 papers comprising 2,582 trauma patients were included. The vacuum closure revealed the lowest mortality (13%; 95% CI: 6–19) and DFC rate of 74% (95% CI: 67-82). The highest mortality (35%; 95% CI: 7-63) and the highest DFC rate (96%; 95% CI: 93–99) were found with the skin-only closure. In the second classification analysis, DT revealed superior outcomes than ST in terms of all endpoints. Data reuse potential: Clinical outcome data in this Data in Brief paper may provide useful basis for future well-designed, high-quality, and highly powered trials using various TAC, which will validate positive findings of this dataset with more reliability.