An evaluation of intra-abdominal pressures and its outcomes in patients undergoing emergency laparotomy

Background: Intraabdominal hypertension (IAH) is defined as a sustained or repeated pathologic elevation of IAP of greater than 12 mm Hg. The presence of IAH is associated with an 11-fold increase in mortality compared with patients without IAH.
Aims and objectives: This single centre clinical prospective observational study aimed at determining the incidence of intra-abdominal hypertension in patients undergoing emergency laparotomy and to study the outcomes in patients with raised intra-abdominal pressures in terms of morbidity (occurrence of burst abdomen) and mortality.
Materials and methodology: The study was conducted in a tertiary care teaching hospital in 100 patients undergoing emergency laparotomy after obtaining approval from the institutional ethics committee, over a period of 2 years from January 2016 to December 2017. The abdominal pressure was indirectly determined by measuring urinary bladder pressure with a Foley catheter.
Results: Incidence of IAH in patients: Pre-op IAH: 79%, IAH at 6 hours post-op: 11%, IAH at 24 hours post-op: 7 %, IAH at 48 hours post-op: 1%. There was significant association between increasing grade of IAH preoperatively with increasing morbidity. There was significant association between increasing grade of IAH preoperatively and post-operatively at 6 hours and 24 hours with mortality (P = 0.00). All patients with Grade IV IAH preoperatively did not survive.
Conclusion: The identification of patients at risk of developing IAH/ACS by screening measures of IAP is important and helps undertake effective preventive therapeutic actions.