Duration of open abdomen and complex abdominal wall closure in abdominal trauma: exploratory analysis of a retrospective cohort

Abstract

Objective: To evaluate the association between open abdomen (OA) duration and the need for complex abdominal wall closure in abdominal trauma patients undergoing damage control surgery (DCS).

Materials and Methods: We conducted a single-center retrospective study (2021–2025) including adults managed with OA after index laparotomy for DCS. The primary exposure variable was the duration of OA until definitive fascial closure. The primary outcome was complex closure, defined as the need for advanced reconstructive techniques. Patients who died before fascial closure were excluded from the primary analysis. Descriptive analysis, Fisher’s exact test, Mann–Whitney test, and exploratory ROC analysis with the Youden index were performed.

Results: A total of 45 patients were included; overall in-hospital mortality was 13.3% (6/45). Four patients died before fascial closure, leaving 41 patients for the primary analysis. Complex closure occurred in 9.8% (4/41). No complex closures were observed when fascial closure was achieved within ≤3 days (0/29), whereas the rate was 33.3% (4/12) when closure occurred at ≥4 days (p=0.0049). Patients requiring complex closure had a longer OA duration than those with simple closure (4.5 [IQR 4.0–7.75] vs 2 days [IQR 2–3]; p=0.0058). Exploratory ROC analysis identified 4 days as the optimal cutoff (AUC 0.899).

Conclusion: In this cohort, longer OA duration was associated with a higher need for complex closure. The 4-day threshold should be interpreted as exploratory and requires external validation.