Kalsom Abdulah1, Yuzaidi Mohamad1 and Shahrun Niza B Abdullah Suhaimi2*
1Department of Surgery, Hospital Sultanah Aminah, Johor Bahru, Malaysia
2Department of Surgery, UKM Medical Center, Kuala Lumpur, Malaysia
Background: Damage control surgery using Open Abdomen (OA) for intraabdominal injuries has
come a long way from its initial use during wartimes in 1940 as reported by Ogilvie. Open abdomen
treatment is proven to reduce rates of intraabdominal hypertension following post-intraabdominal
trauma and to produce better immediate patient outcomes in Damage Control Surgery (DCS).
However, a deficit of information on its effects on quality of life in patients has led to reluctance
to use it in our local setting. This study aims to provide more information on the effects of open
abdomen treatment and to help us better understand the usage and prove that this treatment does
not affect the quality of life in trauma patients in the long run and can be adapted as a possible
routine treatment in DCS for intraabdominal injuries in future.
Methods: This is a single-center prospective cohort study of trauma patients who suffered blunt or
penetrating abdominal trauma and underwent either the open abdomen or the closed abdomen DCS
under an emergency setting in Hospital Sultanah Aminah Johor Bahru from January 2018 to May
2019. Patients were called for a follow-up interview 6 months to 12 months after their surgery in the
surgical outpatient clinic or via phone interview. Patients would answer a questionnaire (RAND-
36) to assess 9 different domains pertaining to the quality of life (i.e., physical function, emotional
well-being, etc.). Length of hospital stay, duration of ICU stays and post-operative complications
(i.e., enterocutaneous fistula, Intraabdominal Hypertension (IAH) requiring relaparotomy) were
obtained from the trauma registry of the same hospital. Independent t-test was used to compare all
nine quality of life domains and length of hospital and ICU stay, and the chi-square test was used to
compare rates of post-operative complications.
Results: Sixty-three patients were recruited for this study; 27 in the Open Abdomen (OA) arm and
36 in the closed Abdomen Arm (CA). Mean ± SD ISS score was 14.11 ± 4.81 for the OA group and
12.44 ± 3.64 for the CA group (p: 0.12). Our study shows no significant differences in length of
hospital stay, development of chronic post-op pain, and the incidence of enterocutaneous fistula
or incisional hernia. However, there are significant differences in the duration of ICU stay, rates of
relaparotomy secondary to IAH and social functioning. Mean ± SD for the duration of ICU stay is
6.00 ± 2.48 in OA; 0.75 ± 1.74 in CA (p<0.05). Mean ± SD for social functioning is 71.83 ± 22.61 in
OA; 84.50 ± 17.92 in CA (p: 0.016). Odds ratio ± 95% CI for relaparotomy secondary to IAH is 1.16
± 1.01 (p: 0.04). Interestingly, only a single patient was reported to develop enterocutaneous fistula
from the OA group, and only 2 patients developed an incisional hernia, both from the OA group,
which is not statistically significant based on chi-square analysis.
Conclusion: There is no significant difference in the development of other post-operative
complications, and both groups generally acquire a good quality of life in the long run. Open
abdomen treatment can be well adapted into the practice of Damage Control Surgery (DCS) without
the fear of diminishing the patient’s quality of life.
Intraabdominal injury; Quality of life; Open abdomen; Laparostomy; Trauma; Damage control surgery
Abdulah K, Mohamad Y, Abdullah Suhaimi SNB. Impact of Open Abdominal Wound on Quality of Life in Trauma Patients. World J Surg Surgical Res. 2020; 3: 1225..