Jason Clark, MD, FACS
Director of General Surgery Residency
HCA Healthcare/Mercer University School of Medicine, Trident Hospital System, United States
Disclosure information not submitted.
Darwin Ang, MD , PhD, FACS
HCA/UCF General surgery program director, ORMC trauma medical director
UCF/HCA General surgery Program , Ocala Regional Medical Center, United States
Disclosure information not submitted.
Liu Huazhi, n/a
Sr. Trauma Research Analyst
Ocala Regional Medical Center, United States
Disclosure information not submitted.
Title: The incidence of abdominal compartment syndrome in trauma versus non-trauma hospitals
Introduction: Abdominal compartment syndrome (ACS) is defined as a sustained Intra-abdominal pressure >20mmHg that is associated with a new organ dysfunction. Different risk factors have been associated with the development of ACS, which includes but not limited to, increase in intra-abdominal content, increase in intra-luminal content, decrease abdominal wall compliance and critical ill patients. This study aims to Identifying the development of ACS on trauma versus non-trauma centers and the risk factor associated with it.
Methods: This is a retrospective study using deidentified data from the Florida’s Agency of Healthcare Database (AHCA) from 1991 to 2020. All patients identified with ACS were reviewed. To keep separate trauma centers (TC) from non-trauma centers (NTC), only the last five years were used as there were no new TC added after 2015. Primary outcomes reviewed were development of ACS. Secondary outcomes were mortality, ICU days, # of surgeries, hospital days, and complication rates. A multivariate regression analysis was performed to adjust for confounders. Outcomes were risk adjusted for age, diabetes, hypertension, coronary artery disease, and intestinal disorders using multivariable regression.
Results: 2,834,007 patient in NTC and 1,164,868 patients in TC were identified with ACS and included from 2015 to 2020 in the state of Florida. Patients in NTC tended to be older ( >64 years: 58% v 48%, p< 0.0001), identify as white (66.7% v 59.0%, p< 0.0001) and less ill (ICISS >0.96: 17.0% v 18.4%, p< 0.0001). TC were more likely to identify ACS (0.08% v 0.02%, p< 0.0001). Complications were more apparent in NTC (13.6% v 12.8%, adj p< 0.0001) but mortality was higher in TC (5.3% v 4.2%, p< 0.0001). TC had longer hospital days (7.8 v 6.2, p< 0.0001) and more surgeries (3.1 v 2.1, p< 0.0001). Shock was more prevalent in TC (3.6% v 2.7%, p< 0.0001) while signs of fluid overload were seen more in NTC (41.0% v 38.7%, p< 0.0001). The incidence was relatively unchanged over 5 years for NTC and TC for ACS.
Conclusion: The incidence of ACS has changed little over the last five years for trauma and non-trauma centers. ACS was identified more in TC than NTC. ACS is more likely secondary to fluid overload in non-NTC while it may be likely secondary to shock in TC. TC are more likely to have younger but more critically ill patients.