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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.

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