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Trends in Non-Traumatic Abdominal Compartment Syndrome
John Afthinos*, Karen E. Gibbs
Staten Island University Hospital, Bayside, NY
Introduction: Although abdominal compartment syndrome (ACS) has been recognized as a clinical entity since the early part of the 20th century, there has been a long delay in accepting it as a cause of death in critically ill patients. If left untreated it is uniformly fatal. Current literature reports a mortality rate of 50% even when treated. We sought to evaluate the trend in diagnosis of ACS and its mortality in a large national database.
Methods: The NIS database was queried for the years 2005 to 2010. All patients developing non-traumatic ACS were identified. The most common associated diagnoses were recorded. The population was evaluated for age, gender, comorbid conditions and post-operative complications Bivariate logistic regression analyses were performed to identify risk factors for mortality.
Results: We identified a total of 10,345 patients. The patients were largely male (59%) and were 54.4 + 22 years old. In 2006, there were only 184 cases, increasing to 3453 in 2010. Ruptured abdominal aortic aneurysm, sepsis, pancreatitis, adhesive bowel obstruction and mesenteric ischemia were among the more common associated diagnoses. Post-operative morbidity was 85% and mortality was 50%. Significant risk factors predictive of mortality were history of MI (OR 1.9), COPD (OR 1.3), PVD (OR 1.9), CAD (OR 1.4) and severe liver disease (OR 2, p < 0.05). Persistent post-operative acidosis was the strongest predictor of post-operative mortality (OR 2, p < 0.001).
Conclusions: ACS is increasingly recognized as an important clinical entity. It carries a very high mortality rate, even when treated. It is unclear from the study if this is due to the natural course of the primary disease or delayed recognition. The high mortality rate suggests that patients should be aggressively assessed for its presence in the early phases of treatment in order to attempt to derail this deadly syndrome.
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