Vacuum-Assisted Closure Significantly Reduces Surgical Postoperative Complications Compared With Primary Abdominal Closure in Patients With Secondary Peritonitis: A Comparative Retrospective Study.

Abstract

Background: Vacuum-assisted abdominal closure (VAC) is being increasingly used as an adjunctive procedure in the surgical treatment of secondary peritonitis. This study compared postoperative mortality and complication rates between VAC and primary abdominal closure (PAC).

Method: This retrospective chart review included all patients diagnosed with secondary peritonitis who underwent laparotomy between 2010 and 2019. Data were collected from six hospitals within Southern Denmark, covering a population of approximately 1,225,000 inhabitants.

Results: The study involved 315 patients (139 in the PAC and 176 in the VAC groups). In the VAC group, BMI, ASA, SOFA, MPI, and four quadrant contamination was significantly higher at the index operation. There were no significant differences in nonadjusted and adjusted postoperative mortality at 30 days, 90 days, and 1 year, with cumulative values of 13%, 16%, and 21%, respectively, compared with 16%, 21%, and 31%, in the PAC group (p = 0.519, p = 0.380, and p = 0.051, respectively). Cumulative adjusted surgical postoperative complications at 30 days, 90 days, and 1 year, as assessed by the comprehensive complication index, was significantly higher in the PAC group. Reoperations were significantly more common in the PAC group. The total length of the intensive care unit admission was significantly longer in the VAC group, with a mean of 9.0 ± 12.1 versus 6.7 ± 12.1 days (p < 0.001).

Conclusion: VAC after laparotomy for secondary peritonitis did not significantly reduce mortality but increased ICU stay, whereas primary closure led to higher surgical complication rates and reoperations.