Outcomes in surgical versus medical patients with the secondary abdominal compartment syndrome

BACKGROUND: Secondary abdominal compartment syndrome (SACS) is a well-recognized sequelae of massive fluid resuscitation in surgical patients, but has only anecdotally been reported in the medical patient population. The purpose of this study was to compare the clinical scenarios, physiologic indices, and outcomes of patients with SACS due to medical versus trauma etiologies. METHODS: Patients undergoing decompression for SACS from January 1999 to January 2006 were identified using our computerized operative records. RESULTS: During the 7-year study period, 54 patients developed SACS (41 postinjury patients and 13 medical patients). There were no significant differences in demographics, physiologic indices, or fluid resuscitation between the medical and postinjury groups: age (46.6 +/- 4.7 vs 40.6 +/- 2.3), bladder pressure (33.5 +/- 1.1 vs 32.8 +/- 1.8), peak airway pressures (45.9 +/- 2.4 vs 49.3 +/- 2.1), base deficit (14.6 +/- 1.4 vs 13.6 +/- 1.1), and fluids (18.5 +/- 1.8 vs 16.0 +/- 1.5 liters). Patients with a medical cause of SACS had a significantly longer time to decompression (21 +/- 3.6 versus 6.5 +/- 1.9 hours), significantly higher incidence of MOF (62% v 27%), and trend toward greater mortality (54% versus 34%). CONCLUSIONS: Patients with diverse disease processes may develop SACS. Despite similar age and physiologic indices, the MOF and mortality rates associated with medical SACS are markedly higher. These findings highlight the need for routine monitoring in at-risk patients, prevention of pathologic intra-abdominal hypertension, and a low threshold for decompression.