Predicting planned ventral hernia in trauma patients: The role of end-organ dysfunction versus fluid resuscitation.

INTRODUCTION

Critically ill trauma patients often suffer complex abdominal injuries that can result in planned ventral hernia (PVH). This study evaluated patient factors and critical care parameters that may predict PVH.

METHODS

A retrospective study was performed for post-laparotomy patients at a level 1 trauma center between 2020 and 2022. Demographics, injury characteristics, and outcomes were abstracted, and patients were stratified into two groups: fascial closure (FC) versus PVH by discharge. Multivariable logistic regression (MLR) was performed for PVH.

RESULTS

Of the 899 patients reviewed, 80 ​% were male, 65 ​% suffered a penetrating mechanism, and 33 ​% underwent damage control laparotomy (DCL). There were 64 (7 ​%) patients with PVH. PVH patients had more unplanned operations (83 ​% vs. 8.8 ​%,p ​< ​0.0001), more intra-abdominal abscesses (45 ​% vs. 12 ​%,p ​< ​0.0001), more intravenous fluid (IVF) administered at 24 ​h (12L vs 6L,p ​< ​0.0001), and more packed red blood cell (PRBC) transfusions at 24 ​h (6U vs 1U,p ​< ​0.0001). On MLR, increased body mass index (BMI) (AOR 1.01; CI 1.00-1.02,p ​= ​0.041), gastrointestinal tract injury (AOR 5.29; CI 2.27-12.32,p ​= ​0.0001), DCL (AOR 5.31,CI 2.82-10.01,p ​< ​0.0001), early renal replacement therapy (RRT) (AOR 3.81, CI 1.29-11.22,p ​= ​0.015), and early vasopressor use (AOR 3.94, CI 1.93-8.02,p ​= ​0.0002) were independently associated with PVH (Table 1). Neither IVF administration nor PRBC transfusion at 24 ​h was a predictor of PVH.

CONCLUSION

Early organ dysfunction requiring support was associated with PVH in post-laparotomy trauma patients, while volume resuscitation was not a predictor. Identifying patients at increased risk of PVH may improve operative decisions, prevent PVH, and better anticipate clinical courses.