Feeding the Open Abdomen

Abstract

Background: The purpose of this study was to determine if early enteral nutrition improves outcome for trauma patients with an open abdomen (OA). Methods: Retrospective review was used to identify 78 patients who required an OA for ≥4 hospital days, survived, and had available nutrition data. Demographic data and nutrition data comprising enteral nutrition initiation day and daily % target goal were collected. Patients were divided into 2 groups: early enteral feeding (EEN), initiated ≤4 days within celiotomy; and late enteral feeding (LEN; >4 days). Outcomes included infectious complications, early closure of the abdominal cavity (<8 days from original celiotomy), and fistula formation. Results: Fifty-three of 78 (68%) patients were men, with a mean age of 35 years; 74% had blunt trauma. Forty-three of 78 (55%) patients had EEN, whereas 35 of 78 (45%) had LEN. There was no difference with respect to demographics, injury severity, or infectious complication rates. Thirty-two of 43 (74%) patients with EEN had early closure of the abdominal cavity, whereas 17 of 35 (49%) patients with late feeding had early closure (p = .02). Four of 43 (9%) patients with EEN demonstrated fistula formation, whereas 9 of 35 (26%) patients with late feeding formed fistulae (p = .05). The EEN group had lower hospital charges (p = .04) by more than $50,000. Conclusions: EEN in the OA was associated with (1) earlier primary abdominal closure, (2) lower fistula rate, (3) lower hospital charges.

Seventy-eight patients undergoing at least 4 hospital days of open abdomen care were evaluated in terms of nutrition provision, infectious complications, and noninfectious complications. Patients who received early enteral feedings had less fistulae formation, earlier abdominal wall closure, and lower hospital charges.