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Feeding the Open Abdomen

Bryan Collier, DO, Oscar Guillamondegui, MD, Bryan Cotton, MD, Rafe Donahue, PhD^*, Andrew Conrad, BS, Kate Groh, BS, Jill Richman, BS, Todd Vogel, MD, MPH, Richard Miller, MD and Jose Diaz, Jr, MD

From the ^* Department of Biostatistics, Section of Surgical Sciences, and Division of Trauma and Surgical Critical Care, Vanderbilt University Medical Center, Nashville, Tennessee; Vanderbilt University School of Medicine; and the University of Washington, Harborview Medical Center

Correspondence: Bryan Collier, DO, CNSP, FACS, Trauma Patient Care Center, Vanderbilt University Medical Center, 404 Medical Arts Building, 1211 21^st Avenue, Nashville, TN 37212. Electronic mail may be sent to bryan.collier{at}vanderbilt.edu.

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.

Journal of Parenteral and Enteral Nutrition, Vol. 31, No. 5, 410-415 (2007)
DOI: 10.1177/0148607107031005410


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