Expeditious Diagnosis and Laparotomy for Patients with Acute Abdominal Compartment Syndrome May Improve Survival

Abstract

Causes of abdominal compartment syndrome (ACS) are varied and can result from both medical and surgical diseases. Early recognition of ACS and prompt surgical treatment has been shown to improve mortality. We hypothesize that earlier recognition of ACS and earlier involvement by surgical specialists may improve mortality. A retrospective review between July 2010 and July 2015 was performed of adult patients who underwent decompressive laparotomy for ACS. Patients were divided into surgical and medical intensive care units (SICU and MICU) arms. Twenty patients were included (MICU = 12; SICU = 8) without significant difference between the groups. Median time from admission to suspicion for MICU patients was 60 hours versus 13 hours for SICU patients (P = 0.013). Time from suspicion to surgical consult was 60 minutes versus 0 minutes, respectively (P = 0.003), however, time from surgical consult to intervention was not different. Mortality rate in the MICU was 83 per cent versus 12.5 per cent in the SICU (P = 0.005). Patients in the SICU who developed ACS were more quickly diagnosed than those in the MICU. These patients had a shorter time from suspicion of ACS to surgical consultation and eventual surgical intervention, and was associated with improved survival. A multidisciplinary approach, including early surgical consultation, for patients in whom there is a suspicion of ACS may contribute to improved mortality.