Longterm Impact of Abdominal Decompression: A Prospective Comparative Analysis

BACKGROUND: Abdominal decompression is widely used to treat end-organ dysfunction associated with intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS). The longterm impact of abdominal decompression on physical and mental health, quality of life, and subsequent employment remains unclear. STUDY DESIGN: A prospective cohort study was performed at a tertiary referral/Level I trauma center. All patients who required abdominal decompression for more than 48 hours were asked to complete the SF-36v2 health survey at regular intervals for 2 years postdecompression. Patients discharged with a chronic incisional hernia (OPEN) were compared with those discharged with primary fascial Closure (CLOSED) and with the general Population. Quality-adjusted life years (QALYs) and successful return to employment were determined. RESULTS: From June 2002 to May 2005, 245 consecutive patients required abdominal decompression for intraabdominal hypertension and abdominal compartment syndrome. Forty-four patients (30 OPEN, 14 CLOSED) met inclusion criteria and completed their health surveys. At 6 months postdecompression, physical and social functioning were significantly decreased among OPEN, but not CLOSED, patients when compared with the general Population. By 18 months, OPEN patients demonstrated normal physical and mental health perception. OPEN and CLOSED patients exhibited decreased, but identical, quality-adjusted life years (1.20 +/- 0.11 versus 1.23 +/- 0.25 mean +/- SD]; p = 0.39) and similar ability to resume employment (41% versus 55%; p = 0.49). CONCLUSIONS: Abdominal decompression does not have a negative impact on longterm physical or mental health perception. Quality of life and ability to resume employment are [lot improved by same-admission primary fascial closure. Abdominal decompression is not as debilitating and life altering as might be expected. (J Am Coll Surg 2008;207:573-579. (C) 2008 by the American College Of Surgeons)