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Case Report Form – online submission form Demographic dataMedical Center: _____________________________Centre Study ID: _____________________________Age: (year)_____________________________Gender:male ____________female ____________Height: (cm) ____________Weight: (kg)____________Randomized to: (open vs closed abdomen)Randomization date: mm/dd/yyyytime: hh:mm ____:____ (24 h)Patient COOL Study Code: (generated online) ____________________Primary Outcome DataPatient status at 90 days post-enrollmentAlive___________Dead ___________If deceased date and time of deathmm/dd/yyyy 24 HR ___:___Demographic DataSabadell Score ADDIN EN.CITE <EndNote><Cite><Author>Fernandez</Author><Year>2006</Year><RecNum>4708</RecNum><DisplayText>(1)</DisplayText><record><rec-number>4708</rec-number><foreign-keys><key app="EN" db-id="stztps0ztpzzdpevs2m5aaf0avdzez2vpap2" timestamp="0">4708</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Fernandez, R.</author><author>Baigorri, F.</author><author>Navarro, G.</author><author>Artigas, A.</author></authors></contributors><auth-address>Critical Care Centre, Hospital de Sabadell, Parc Tauli s/n, 08208, Sabadell, Spain. rfernandez@cspt.es</auth-address><titles><title>A modified McCabe score for stratification of patients after intensive care unit discharge: the Sabadell score</title><secondary-title>Critical care</secondary-title><alt-title>Crit Care</alt-title></titles><alt-periodical><full-title>Crit Care</full-title></alt-periodical><pages>R179</pages><volume>10</volume><number>6</number><edition>2006/12/29</edition><keywords><keyword>Adult</keyword><keyword>Age Factors</keyword><keyword>Aged</keyword><keyword>Cohort Studies</keyword><keyword>Critical Illness/mortality</keyword><keyword>Female</keyword><keyword>*Hospital Mortality</keyword><keyword>Hospitals, University</keyword><keyword>Humans</keyword><keyword>*Intensive Care Units</keyword><keyword>Male</keyword><keyword>Middle Aged</keyword><keyword>Multivariate Analysis</keyword><keyword>*Patient Discharge</keyword><keyword>Predictive Value of Tests</keyword><keyword>Prospective Studies</keyword><keyword>ROC Curve</keyword><keyword>Risk Assessment</keyword></keywords><dates><year>2006</year></dates><isbn>1466-609X (Electronic)
1364-8535 (Linking)</isbn><accession-num>17192174</accession-num><work-type>Evaluation Studies</work-type><urls><related-urls><url>;(1) should be scored if possible, after a) ICU discharge b) hospital dischargeUpon ICU Discharge (choose one answer); ______good prognosis with full intention for ICU re-admission and provision of life support if required (0 points) ______ poor long-term prognosis (> 6 months) with unlimited ICU readmission and provision of life support (1 point)______ poor short-term prognosis (< 6 months) with debatable ICU readmission and provision of life support (2 points)______ death expected during hospitalization ICU readmission and provision of life support not recommended (3 points)Upon ICU Discharge (choose one answer); ______good prognosis with full intention for ICU re-admission and provision of life support if required (0 points) ______ poor long-term prognosis (> 6 months) with unlimited ICU readmission and provision of life support (1 point)______ poor short-term prognosis (< 6 months) with debatable ICU readmission and provision of life support (2 points)______ death expected during hospitalization ICU readmission and provision of life support not recommended (3 points) (For the purposes of COOL ICU re-admission equates to the provision of aggressive life support measures, Charlson Co-Morbidity score definitions (See Appendix A for Data Dictionary if required) ADDIN EN.CITE <EndNote><Cite><Author>Charlson</Author><Year>1987</Year><RecNum>16215</RecNum><DisplayText>(2)</DisplayText><record><rec-number>16215</rec-number><foreign-keys><key app="EN" db-id="stztps0ztpzzdpevs2m5aaf0avdzez2vpap2" timestamp="1512700227">16215</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Charlson, M. E.</author><author>Pompei, P.</author><author>Ales, K. L.</author><author>MacKenzie, C. R.</author></authors></contributors><titles><title>A new method of classifying prognostic comorbidity in longitudinal studies: development and validation</title><secondary-title>J Chronic Dis</secondary-title></titles><periodical><full-title>J Chronic Dis</full-title></periodical><pages>373-83</pages><volume>40</volume><number>5</number><keywords><keyword>Actuarial Analysis</keyword><keyword>Age Factors</keyword><keyword>Breast Neoplasms/epidemiology</keyword><keyword>*Epidemiologic Methods</keyword><keyword>Female</keyword><keyword>Follow-Up Studies</keyword><keyword>Humans</keyword><keyword>*Longitudinal Studies</keyword><keyword>*Morbidity</keyword><keyword>New York City</keyword><keyword>Prognosis</keyword><keyword>Prospective Studies</keyword><keyword>Risk</keyword></keywords><dates><year>1987</year></dates><isbn>0021-9681 (Print)
0021-9681 (Linking)</isbn><accession-num>3558716</accession-num><urls><related-urls><url>;(2) Preoperative data (Data Dictionary Appendix A)Date (within 24 h prior to operation): (mm/dd/yyyy)Comorbidity:(medical history)Myocardial infarct, (yes/no)congestive heart failure,(yes/no)Cerebrovascular disease, (yes/no)hemiplegia, (yes/no)Peripheral vascular disease, AAA(yes/no)Connective tissue disease, (yes/no)Immunosuppression/steroids use/chemotherapy,(yes/no)Smoking,(yes/no)Pulmonary diseaseMild(yes/no)Moderate(yes/no)severe(yes/no)Diabetics (without end organ damage), (yes/no)Diabetics with end organ damage, (yes/no)Cancer (without metastasis), (yes/no)Cancer with metastasis,(yes/no)Leukemia/lymphoma, (yes/no)Dementia,(yes/no)Kidney DysfunctionSevere organ dysfunction (kidney, liver),(yes/no)Presence of ostomy/incisional hernia(yes/no)HIV infection(yes/no)HIV infection with complications(yes/no)Liver diseaseMild(yes/no)Moderate(yes/no)Severe(yes/no)ASA status: American Society of Anesthesiologists Physical Status Classification (select one)Healthy patientMild systemic disease, no function limitationSevere systemic disease, definitive function limitationSevere systemic disease that is a threat to life Moribund patient unlikely to survive 24 h with or without operationEnrollment illness severity data: APACHE 2 ScoringSOFA ScoringSOFA score: Sepsis related Organ Failure Assessment (record worst score by circling value at Enrollment or ICU Admission)SOFA score1234RespirationPaO2/FiO2, mmHg<400<300<200<100---with respiratory support----CoagulationPlatelets X 10?/mm?<150<100<50<20LiverBilirubin, mg/dl1.2-1.92.0-5.96.0-11.9>12.0(?mol/l)(20-32)(33-101)(102-204)(>204)CardiovascularHypertension MAP<70 mmHg Dopamine<=5 Dopamine>5 Dopamine>15 or dobutamine or epinephrine<=0.1 or epinephrine>0.1(any dose) or norepinephrine<=0.1 or norepinephrine>0.1Central nervous systemGCS13-1410-12 6-9 <6RenalCreatinine, mg/dl1.2-1.92.0-3.4 3.5-4.9 >5.0(μmol/l)(110-170)(171-299) (300-440) (>440)Quick-SOFAPatient location immediately prior to intra-operative recruitment: (Ward vs ICU or ED)WardICUEDEnrollment APACHE II score (if admitting ICU): (Record worst score)Sepsis Criteria prior to enrollment (worst values within 2 hours of source control laparotomy)Quick SOFA (Respiratory Rate ______ breaths/minute(Heart Rate _______ beats/minute if not intubated or intubated ( yes/no) ____________(mental status) normal _______ or obtunded _________Sepsis scoring During Index LaparotomyAny vasopressor use during source control laparotomy yes/no __________CPIRO Scoring ADDIN EN.CITE <EndNote><Cite><Author>Posadas-Calleja</Author><Year>(in press)</Year><RecNum>16213</RecNum><DisplayText>(3)</DisplayText><record><rec-number>16213</rec-number><foreign-keys><key app="EN" db-id="stztps0ztpzzdpevs2m5aaf0avdzez2vpap2" timestamp="1512531450">16213</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Posadas-Calleja, J. G.</author><author>Stelfox, H. T.</author><author>Ferland, A.</author><author>Zuege, D. J.</author><author>Niven, D. J.</author><author>Berthiaume, L.</author><author>Doig, C. J.</author></authors></contributors><titles><title>Derivation of a PIRO score for prediction of mortality in surgical patients with intra-abdominal sepsis/severe sepsis/septic shock</title><secondary-title>Am J Crit Care</secondary-title></titles><periodical><full-title>Am J Crit Care</full-title></periodical><dates><year>(in press)</year></dates><urls></urls></record></Cite></EndNote>(3)Predispositionage (years)______ yearsAPACHE II ADDIN EN.CITE <EndNote><Cite><Author>Knaus</Author><Year>1985</Year><RecNum>7780</RecNum><DisplayText>(4)</DisplayText><record><rec-number>7780</rec-number><foreign-keys><key app="EN" db-id="stztps0ztpzzdpevs2m5aaf0avdzez2vpap2" timestamp="0">7780</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Knaus, W. A.</author><author>Draper, E. A.</author><author>Wagner, D. P.</author><author>Zimmerman, J. E.</author></authors></contributors><titles><title>APACHE II: A severity of disease clasification</title><secondary-title>Crit Care Med</secondary-title></titles><periodical><full-title>Crit Care Med</full-title></periodical><pages>818-829</pages><volume>13</volume><dates><year>1985</year><pub-dates><date>1985</date></pub-dates></dates><label>8850</label><urls></urls></record></Cite></EndNote>(4) comorbid conditions present(yes/no)(Heart Failure Class IV, cirrhosis, chronic lung disease, or dialysis-dependent) ResponseLeukopenia (Defined as WBC <4000)(yes/no)Hypothermia(Defined as a temperature less than 36 degrees Celsius)(yes/no)Organ Dysfunction(Defined as Cardiovascular dysfunction (defined as Mean arterial pressure < 70 mmHg OR administration of?any vasopressor medications)(yes/no)Respiratory Dysfunction?(Defined as PaO2/FiO2 (mmHg)?<300)(yes/no)Renal Dysfunction?Creatinine > 171 umol/L (2 mg/dl) OR < 500 ml urine day(yes/no)CNS Dysfunction?(Defined as Glasgow Coma Scale?≤?12(yes/no)World Society of Emergency Surgery Sepsis severity score (WISS/WSES)PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5TYXJ0ZWxsaTwvQXV0aG9yPjxZZWFyPjIwMTU8L1llYXI+
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ADDIN EN.CITE.DATA (6, 7)Setting of acquisition? Healthcare associated infection (yes/no)Origin of the IAIs? Colonic non-diverticular perforation peritonitis (yes/no)? Small bowel perforation peritonitis (yes/no)? Diverticular diffuse peritonitis (yes/no)? Post-operative diffuse peritonitis (yes/no)Delay in source control? Delayed initial intervention [Preoperative duration of peritonitis (localized or diffuse) > 24 h)] (yes/no)Risk factors? Age>70 _______ yrs? Immunosuppression (chronic glucocorticoids, immunosuppressant agents, chemotherapy, Lymphatic diseases, virus) (yes/no)Other Pre-Operative Demographic VariablesV)prior_general_surgeryhas the patient had intra-abdominal surgery before during this same admission or is this a complication of a recent intra-abdominal surgical procedure if readmitted following1 = prior surgery0 = no prior surgery (COOL enrollment at first operation)W)prior_abdominal_ Procedureif any prior abdominal surgery in this admission or recently for which the patient was readmitted – describe in textY)prior_hosp_loslength of stay prior to enrollment operation in hours(days/hours)Z)place_to_ORWhere was the patient prior to being taken to the OR for (_________)the enrollment surgery1 = ER2 = ward 3 = main ICU4 = CVICU (cardiovascular Intensive Care Unit)5 = transferred rom another hospitalIntraoperative dataDate of laparotomy: (mm/dd/yyyy)Indications to the intervention:Intra-Abdominal source of infection (yes/no)Bowel ischemia(yes/no)Bowel obstruction/ileus (yes/no)Bowel perforation(yes/no)Abdominal traumatic injury(yes/no)Blunt(yes/no)Penetrating(yes/no)Iatrigenic(yes/no)Other (specify)________________________________________________________________________________________________________Original organ of infection:Appendicitis(yes/no)Cholecystitis(yes/no)Post-operative(yes/no)Colonic non diverticular perforation(yes/no)Gastro-duodenal perforations(yes/no)Diverticulitis(yes/no)Small bowel perforation(yes/no)Others (specify) _________________Unable to tellPID (yes/no)Post traumatic perforation(yes/no)Anastomotic breakdown; yes/no if yes – type of anastomosis ____________________Type of intra-operative exudate:Clear (yes/no)Cloudy, (yes/no)Purulent(yes/no)Fecal (yes/no)Vegetable material(yes/no)Location of exudate/contamination (select all apply):Right upper quadrant(yes/no)Right lower quadrant (yes/no)Left upper quadrant (yes/no)Left lower quadrant(yes/no)Another site (specify) ____________________Manheim Peritonitis Score at Enrollment LaparotomyFluid instillation/washing: (yes or no)Type of surgery (specify procedure performed): __________________________________________________________________________________________________________________________________________Postoperative diagnosis (specify):______________________________________________Temporary abdominal closure technique: Type of AbThera if used(Standard AbThera)(yes/no)(AbThera Advance)(yes/no)Intra-operative FluidsCrystalloid fluids ______________ (liters)(Crystalloid refers to saline, Ringers lactate, Hartman’s etc.)Hypertonic Fluids______________ (liters)(Hypertonic refers to hypertonic fluids such as HTS with NaCl content > 0/9%)Natural Colloid fluids______________ (liters)(Natural Colloid refers to a colloid fluid derived from live sources such as albumen)Synthetic Colloid fluids______________ (liters)(Synthetic Colloid refers to a colloid fluid not derived from live sources such as hydroxyethyl starch (HES) solutions as well as the less commonly used dextrans or gelatins)Packed Red Blood Cells______________ unitsFresh Frozen plasma ______________ ml (or liters)Prothrombin Complex______________ ml (or liters)Vasoactive-inotropic scorePEVuZE5vdGU+PENpdGU+PEF1dGhvcj5HYWllczwvQXV0aG9yPjxZZWFyPjIwMTA8L1llYXI+PFJl
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ADDIN EN.CITE.DATA (8, 9)(Use highest value at any point in the operation)Vasopressors given during index source control laparotomy _________ (yes/no)If yes;Dopamine ______________ug/kg/minDobutamine______________ug/kg/minNorepinephrine_______________ug/kg/minMilrinone_______________ug/kg/minVasopressin_______________ug/kg/minNeosynephrine_______________TOTAL ugs given during operationEphedrine_______________TOTAL ugs given during operationPost-Operative CareHospitalization data (only requires completion once and not daily)90-day post-operative dataICU discharged: (yes or no)ICU discharge date: (mm/dd/yyyy)Total ICU stay time: (____ days and hours)Total ventilation time: (____ days and hours)Patient died (yes/no)If died ?date and time of death mm/dd/yr_______________Withdrawal of care(yes/no)(Withdrawal of care is defined as the discontinuation of life sustaining therapies with the expectation that the patient will die without this support)Hospital discharged: (yes or no)Discharge date: (mm/dd/yyyy)Total hospital stay time: (____ days)Discharge Locationhome (yes/no)Rehab facility with the expectation of eventual home discharge (yes/no)Long-term care Facility with unknown expectation of eventual home discharge (yes/no)Palliatice care Facility with no expectation of eventual home discharge (yes/no)Abdominal Compartment ManagementSame Stay Fascial closure: (yes or no)(defined as facial closure during the index hospitalization visit)Time between open abdomen opening and definitive closure: (____ days)Negative pressure “subcutaneous therapies” used for a primary closure (yes/no)Type _______________(example use of the Prevena or PICO dressings is permitted for the primary closure study arm)Adjuncts to AbThera for Open Abdomen wound ClosureMesh mediated fascial traction ADDIN EN.CITE <EndNote><Cite><Author>Petersson</Author><Year>2007</Year><RecNum>11290</RecNum><DisplayText>(10)</DisplayText><record><rec-number>11290</rec-number><foreign-keys><key app="EN" db-id="stztps0ztpzzdpevs2m5aaf0avdzez2vpap2" timestamp="0">11290</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Petersson, U.</author><author>Acosta, S.</author><author>Bjorck, M.</author></authors></contributors><auth-address>Department of Surgery, University Hospital Malmo, 205 02 Malmo, Sweden. ulf.a.petersson@</auth-address><titles><title>Vacuum-assisted wound closure and mesh-mediated fascial traction--a novel technique for late closure of the open abdomen</title><secondary-title>World journal of surgery</secondary-title><alt-title>World J Surg</alt-title></titles><alt-periodical><full-title>World J Surg</full-title></alt-periodical><pages>2133-7</pages><volume>31</volume><number>11</number><edition>2007/09/20</edition><keywords><keyword>Abdominal Injuries/*surgery</keyword><keyword>Adolescent</keyword><keyword>Adult</keyword><keyword>Aged</keyword><keyword>Aortic Aneurysm, Abdominal/surgery</keyword><keyword>Aortic Rupture/surgery</keyword><keyword>Edema/therapy</keyword><keyword>Fascia/*surgery</keyword><keyword>Feasibility Studies</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Male</keyword><keyword>Middle Aged</keyword><keyword>Negative-Pressure Wound Therapy/*methods</keyword><keyword>Surgical Mesh</keyword><keyword>Viscera</keyword></keywords><dates><year>2007</year><pub-dates><date>Nov</date></pub-dates></dates><isbn>0364-2313 (Print)
0364-2313 (Linking)</isbn><accession-num>17879112</accession-num><urls><related-urls><url>;(10) (yes/no)duration of use ____________ hoursABBRA fascial traction ADDIN EN.CITE <EndNote><Cite><Author>Mukhi</Author><Year>2014</Year><RecNum>16214</RecNum><DisplayText>(11)</DisplayText><record><rec-number>16214</rec-number><foreign-keys><key app="EN" db-id="stztps0ztpzzdpevs2m5aaf0avdzez2vpap2" timestamp="1512533449">16214</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Mukhi, A. N.</author><author>Minor, S.</author></authors></contributors><auth-address>Dalhousie University, Halifax, NS.</auth-address><titles><title>Management of the open abdomen using combination therapy with ABRA and ABThera systems</title><secondary-title>Can J Surg</secondary-title></titles><periodical><full-title>Can J Surg</full-title></periodical><pages>314-9</pages><volume>57</volume><number>5</number><keywords><keyword>Abdominal Wound Closure Techniques/*instrumentation</keyword><keyword>Adult</keyword><keyword>Aged</keyword><keyword>Equipment Design</keyword><keyword>Fasciotomy</keyword><keyword>Female</keyword><keyword>Follow-Up Studies</keyword><keyword>Hernia, Ventral/mortality/*surgery</keyword><keyword>Herniorrhaphy/*methods</keyword><keyword>Humans</keyword><keyword>Laparotomy</keyword><keyword>Male</keyword><keyword>Middle Aged</keyword><keyword>Negative-Pressure Wound Therapy/*instrumentation</keyword><keyword>Nova Scotia/epidemiology</keyword><keyword>Retrospective Studies</keyword><keyword>Survival Rate/trends</keyword><keyword>Treatment Outcome</keyword><keyword>Wound Healing</keyword></keywords><dates><year>2014</year><pub-dates><date>Oct</date></pub-dates></dates><isbn>1488-2310 (Electronic)
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ADDIN EN.CITE.DATA (12, 13))Renal Replacement Therapy Required (yes/no)Renal replacement therapy time: (__________ days)Any intestinal anastomosis(yes/no) _____________If yes what type ______________Any stoma(yes/no) _____________If yes what type ______________Mesh used to Close Abdominal Wall(yes/no) _____________If yes what type ______________Abdominal Complications: Entero-atmospheric fistula: (yes or no)This is an important complication and as much textual description should be provided including but not limited to;Anatomic location___________________Anastomotic related?(yes/no)Fistula output?Highmediumlow(> 500 ml/day)(500-200 ml/day)(< 200 ml/day) iv)any perceived cause of the fistula?______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Surgical Site Infections (See also appendix C)Superficial incisional SSI (yes/no)Must meet the following criteria: Date of event occurs within 30 days after any NHSN operative procedure (where day 1 = the procedure date) AND involves only skin and subcutaneous tissue of the incision AND patient has at least one of the following: a. purulent drainage from the superficial incision. (yes/no)b. organism(s) identified from an aseptically-obtained specimen from the superficial incision or subcutaneous tissue by a culture or non-culture based microbiologic testing method which is performed for purposes of clinical diagnosis or treatment (for example, not Active Surveillance Culture/Testing (ASC/AST)). (yes/no)c. superficial incision that is deliberately opened by a surgeon, attending physician* or other designee and culture or non-culture based testing of the superficial incision or subcutaneous tissue is not performed AND patient has at least one of the following signs or symptoms: localized pain or tenderness; localized swelling; erythema; or heat. (yes/no)d. diagnosis of a superficial incisional SSI by the surgeon, attending physician* or other designee. * The term attending physician for the purposes of application of the NHSN SSI criteria may be interpreted to mean the surgeon(s), infectious disease, other physician on the case, emergency physician, or physician’s designee (nurse practitioner or physician’s assistant).(yes/no)Deep incisional SSI (yes/no)Must meet the following criteria:The date of event occurs within 30 after the NHSN operative procedure (where day 1 = the procedure date) AND involves deep soft tissues of the incision (for example, fascial and muscle layers) AND patient has at least one of the following: a. purulent drainage from the deep incision. (YES/NO)b. a deep incision that spontaneously dehisces, or is deliberately opened or aspirated by a surgeon, attending physician* or other designee AND organism(s) identified from the deep soft tissues of the incision by a culture or non-culture based microbiologic testing method which is performed for purposes of clinical diagnosis or treatment (for example, not Active Surveillance Culture/Testing (ASC/AST)) or culture or non-culture based microbiologic testing method is not performed. A culture or non-culture based test from the deep soft tissues of the incision that has a negative finding does not meet this criterion. AND patient has at least one of the following signs or symptoms: fever (>38°C); localized pain or tenderness. (YES/NO)c. an abscess or other evidence of infection involving the deep incision that is detected on gross anatomical or histopathologic exam, or imaging test.(YES/NO) * The term attending physician for the purposes of application of the NHSN SSI criteria may be interpreted to mean the surgeon(s), infectious disease, other physician on the case, emergency physicOrgan/Space SSI (YES/NO)Must meet the following criteria: Date of event occurs within 30 days after the NHSN operative procedure (where day 1 = the procedure date) AND involves any part of the body deeper than the fascial/muscle layers that is opened or manipulated during the operative procedure AND patient has at least one of the following: a. purulent drainage from a drain that is placed into the organ/space (for example, closed suction drainage system, open drain, T-tube drain, CT-guided drainage). (YES/NO)b. organism(s) identified from fluid or tissue in the organ/space by a culture or non-culture based microbiologic testing method which is performed for purposes of clinical diagnosis or treatment (for example, not Active Surveillance Culture/Testing (ASC/AST)). (YES/NO)c. an abscess or other evidence of infection involving the organ/space that is detected on gross anatomical or histopathologic exam, or imaging test evidence suggestive of infection. AND meets at least one criterion for a specific organ/space infection site listed in Table 3. These criteria are found in the Surveillance Definitions for Specific Types of Infections chapter.(YES/NO)Abdominal wound ComplicationsDay fascia closed yy/mm/dd ______________Skin closed yes/noSkin reopened or dehiscedyes/noFascia dehisced yes/noReoperation required due to dehiscence yes/noIf YES provide date and details ___________________________Daily DataThis data to be completed Daily until hospital discharge or 30 daysPlease Complete one Form for each Hospital DayDate yyyy/mm/dd___________Day since Enrollment ___________Re-operation: (yes or no)Time of re-operation: (24:00 clock of OR start)Reason for re-operation:Dressing replacementOpen closed fascia, relook Definitive abdominal closureOther (specify) __________________________________________Fascial closure closure: (yes or no)If not closed type of Temporary Abdominal Closure replaced: (specify)______________________Intra-operative findings___________________________________Intra-abdominal hypertensionIntra-abdominal pressure being measured by any method?(yes/no)Intra-abdominal hypertension present?(yes/no)(Intra-abdominal pressure > 12 mmHgPEVuZE5vdGU+PENpdGU+PEF1dGhvcj5LaXJrcGF0cmljazwvQXV0aG9yPjxZZWFyPjIwMTM8L1ll
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ADDIN EN.CITE.DATA (8, 9)(Use highest value in the 24 hour day)Patient received any inotropic Medicationyes/no _____________If patient received inotropic medication please complete;Dopamine ______________ug/kg/minDobutamine______________ug/kg/minNorepinephrine_______________ug/kg/minMilrinone_______________ug/kg/minVasopressin_______________ug/kg/minNeosynephrine_______________TOTAL ugs given during operationEphedrine_______________TOTAL ugs given during operationPost-operative management data (ICU stay)Daily fluid balance: (24 h input minus output, L)SOFA score: (record worst score)Intra-abdominal hypertension: (IAP > 12 mmHg, yes or no)Abdominal compartment syndrome: (IAP > 20 mmHg plus new organ dysfunction, yes or no)Definitive abdominal closure intervention dataDate of intervention: (mm/dd/yyyy)Time between open abdomen opening and definitive closure: (days)Intraoperative blood transfusion or products: (yes or no, if yes, what kinds?)Intestinal anastomosis: (yes or no) In case of intestinal anastomosis: (specify)Stoma: (yes or no, specify what kind?)Prosthesis: (yes or no)Fascial closure: (yes or no)Entero-atmospheric fistula: (yes or no)Skin closure: (yes or no)Complications: (yes or no, if yes, what kinds)About wound: (clean or infection?)Total ICU stay time: (days)Total ventilation time: (days)Perioperative death: (yes or no)Six month Follow-up DataPatient alive (yes/no)If died date?yy/mm/dd _________If alive ?Living location ?home (yes/no)Rehab facility with the expectation of eventual home discharge (yes/no)Long-term care Facility with unknown expectation of eventual home discharge (yes/no)Palliative care Facility with no expectation of eventual home discharge (yes/no)QOLEuroqolSF 36One Year Follow-up DataPatient alive (yes/no)If died date?yy/mm/dd _________If alive ?Living location ?home (yes/no)Rehab facility with the expectation of eventual home discharge (yes/no)Long-term care Facility with unknown expectation of eventual home discharge (yes/no)Palliative care Facility with no expectation of eventual home discharge (yes/no)QOLEuroqolSF 36Appendix Data DictionaryData Dictionary for Charlson Comorbidity Variables ADDIN EN.CITE <EndNote><Cite><Author>Charlson</Author><Year>1987</Year><RecNum>16215</RecNum><DisplayText>(2)</DisplayText><record><rec-number>16215</rec-number><foreign-keys><key app="EN" db-id="stztps0ztpzzdpevs2m5aaf0avdzez2vpap2" timestamp="1512700227">16215</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Charlson, M. E.</author><author>Pompei, P.</author><author>Ales, K. L.</author><author>MacKenzie, C. R.</author></authors></contributors><titles><title>A new method of classifying prognostic comorbidity in longitudinal studies: development and validation</title><secondary-title>J Chronic Dis</secondary-title></titles><periodical><full-title>J Chronic Dis</full-title></periodical><pages>373-83</pages><volume>40</volume><number>5</number><keywords><keyword>Actuarial Analysis</keyword><keyword>Age Factors</keyword><keyword>Breast Neoplasms/epidemiology</keyword><keyword>*Epidemiologic Methods</keyword><keyword>Female</keyword><keyword>Follow-Up Studies</keyword><keyword>Humans</keyword><keyword>*Longitudinal Studies</keyword><keyword>*Morbidity</keyword><keyword>New York City</keyword><keyword>Prognosis</keyword><keyword>Prospective Studies</keyword><keyword>Risk</keyword></keywords><dates><year>1987</year></dates><isbn>0021-9681 (Print)
0021-9681 (Linking)</isbn><accession-num>3558716</accession-num><urls><related-urls><url>;(2) Myocardial infarction - History of definite or probable MI (EKG changes and/or enzyme changesCongestive Heart Failure - Exertional or paroxysmal nocturnal dyspnea and has responded to digitalis, diuretics, or afterload reducing agentsPeripheral vascular disease - Intermittent claudication or past bypass for chronic arterial insufficiency, history of gangrene or acute arterial insufficiency, or untreated thoracic or abdominal aneurysm (≥6 cm)Cerebrovascular disease includes patients with a history of a cerebrovascular accident with minor or no residua and transient ischemic attacksParalysis and Hemiplegia includes patients with the dense hemiplegia or paraplegia, whether it occurred as a result of a cerebrovascular accident or other condition [60% Dementia includes patients with chronic cognitive deficitMild pulmonary disease includes patients who are dyspneic with moderate activity without treatment or those who are dyspneic only with attacks (e.g. asthma) Moderate pulmonary disease includes patients who are dyspneic with slight activity, with or without treatment and those who are dyspneic with moderate activity despite treatmentSevere pulmonary disease includes patients who are dyspneic at rest, despite treatment, those who require constant oxygen, those with CO, retention and those with a baseline PO, below 50 torr 150% Rheumatologic disease includes patients with. systemic lupus erythematous, polymyositis, mixed connective tissue disease‘, polymyalgia rheumatica, and moderate to severe rheumatoid arthritis. Peptic ulcer disease Any history of treatment for ulcer disease or history of ulcer bleedingLiver disease Severe = cirrhosis and portal hypertension with variceal bleeding history, moderate = cirrhosis and portal hypertension but no variceal bleeding history, mild = chronic hepatitis (or cirrhosis without portal hypertension)Diabetes Melitus - None or diet-controlled, Uncomplicated+1, End-organ damage. Severe diabetes includes patients with retinopathy, neuropathy, or nephropathy. Moderate diabetes includes patients who had previous hospitalizations for ketoacidosis, hyperosmolar coma, or control and those with juvenile onset or brittle diabetics. Mild diabetes includes all other diabetes treated with insulin or oral hypoglycemics, but not diet aloneSevere renal disease includes patients on dialysis, those who had a transplant, and those with uremia 150%. Moderate renal insufficiency includes patients with serum creatinine of 23 mg% 162%. Mild renal includes those with serum creatinine of 2-3 mg%.Acquired immune deficiency syndrome (AIDS) includes patients with define or probable AIDS, i.e. AIDS related complex. Lymphoma includes patients with Hodgkins, lymphosarcoma, Waldenstrom’s macroglobulinemia, myeloma, and other lymphomas. Leukemia includes patients with acute and chronic myelogenous leukemia, acute and chronic lymphocytic leukemia, and polycythemia vera. Metastatic cancer includes patients with metastatic solid tumors, including breast, lung, colon and other tumors 185%. Tumor-consists of patients ‘with ‘solid tumors without documented metastases, but initially treated in the last five years, including breast, colon, lung, and a variety of other tumors.Appendix BSepsis severity score (MPI): Mannheim Peritonitis IndexAppendix CFurther Definitions of Surgical Site InfectionsThe following do not qualify as criteria for meeting the NHSN definition of superficial incisional SSI: Diagnosis/treatment of cellulitis (redness/warmth/swelling), by itself, does not meet criterion “d” for superficial incisional SSI. Conversely, an incision that is draining or that has organisms identified by culture or non-culture-based testing is not considered a cellulitis. A stitch abscess alone (minimal inflammation and discharge confined to the points of suture penetration). Circumcision is not an NHSN operative procedure. An infected circumcision site in newborns is classified as CIRC and is not an SSI. An infected burn wound is classified as BURN and is not an SSI. For an NHSN operative procedure, a laparoscopic trocar site is considered a surgical incision and not a stab wound. A localized stab wound or pin site infection is not considered an SSI; depending on the depth, these infections might be considered either a skin (SKIN) or soft tissue (ST) infection.IAB-Intraabdominal infection, not specified elsewhere, including gallbladder, bile ducts, liver (excluding viral hepatitis), spleen, pancreas, peritoneum, retroperitoneal, subphrenic or subdiaphragmatic space, or other intraabdominal tissue or area not specified elsewhere January 2019 17- 22 Surveillance Definitions Intraabdominal infections must meet at least one of the following criteria: 1. Patient has organism(s) identified from an abscess or from purulent material from intraabdominal space by a culture or non-culture based microbiologic testing method which is performed for purposes of clinical diagnosis or treatment, for example, not Active Surveillance Culture/Testing (ASC/AST). 2. Patient has at least one of the following: - a. abscess or other evidence of intraabdominal infection on gross anatomic or histopathologic exam. - b. abscess or other evidence of intraabdominal infection on gross anatomic or histopathologic exam AND organism(s) identified from blood by a culture or non-culture based microbiologic testing method, which is performed for purposes of clinical diagnosis or treatment, for example, not Active Surveillance Culture/Testing (ASC/AST). The organism(s) identified in the blood must contain at least one MBI organism. (See Appendix A of the BSI protocol) 3. Patient has at least two of the following: - fever (>38.0°C), - hypotension, nausea*, - vomiting*, - abdominal pain or tenderness*, - elevated transaminase level(s)*, - or jaundice* And at least one of the following: - a. organism(s) seen on Gram stain and/or identified from intraabdominal fluid or tissue obtained during invasive procedure or from an aseptically-placed drain in the intraabdominal space (for example, closed suction drainage system, open drain, T-tube drain, CT guided drainage) by a culture or non-culture based microbiologic testing method which is performed for purposes of clinical diagnosis or treatment, for example, not Active Surveillance Culture/Testing (ASC/AST). b. organism(s) identified from blood by a culture or non-culture based microbiologic testing method which is performed for purposes of clinical diagnosis or treatment, for example, not Active Surveillance Culture/Testing (ASC/AST). The organism(s) identified in the blood must contain at least one MBI organism (See Appendix A of the BSI protocol) AND imaging test evidence suggestive of infection ( for example, ultrasound, CT scan, MRI, ERCP, radiolabel scans [gallium, technetium, etc.] or on abdominal x-ray), which if equivocal is supported by clinical correlation, specifically, physician documentation of antimicrobial treatment for intraabdominal infection.? * With no other recognized cause Reporting instructions ?Biliary ductal dilatation is considered an equivocal finding for cholangitis. Do not report pancreatitis (an inflammatory syndrome characterized by abdominal pain, nausea, and vomiting associated with high serum levels of pancreatic enzymes) unless it is determined to be infectious in origin. Eligible laboratory results that represent transaminase levels include: serum glutamic oxaloacetic transaminase (SGOT), serum glutamic pyruvic transaminase (SGPT), alanine transaminase (ALT) or aspartate transaminase (AST). Consider the requirement for elevated transaminase level(s) met if at least one is elevated as per the normal range provided by the laboratory.References ADDIN EN.REFLIST 1.Fernandez R, Baigorri F, Navarro G, Artigas A. A modified McCabe score for stratification of patients after intensive care unit discharge: the Sabadell score. Critical care. 2006;10(6):R179.2.Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373-83.3.Posadas-Calleja JG, Stelfox HT, Ferland A, Zuege DJ, Niven DJ, Berthiaume L, et al. Derivation of a PIRO score for prediction of mortality in surgical patients with intra-abdominal sepsis/severe sepsis/septic shock. Am J Crit Care. (in press).4.Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: A severity of disease clasification. Crit Care Med. 1985;13:818-29.5.Sartelli M, Abu-Zidan FM, Catena F, Griffiths EA, Di Saverio S, Coimbra R, et al. Global validation of the WSES Sepsis Severity Score for patients with complicated intra-abdominal infections: a prospective multicentre study (WISS Study). World journal of emergency surgery : WJES. 2015;10:61.6.Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, et al. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock, 2012. Intensive care medicine. 2013;39(2):165-228.7.Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, et al. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012. Critical care medicine. 2013;41(2):580-637.8.Gaies MG, Gurney JG, Yen AH, Napoli ML, Gajarski RJ, Ohye RG, et al. Vasoactive-inotropic score as a predictor of morbidity and mortality in infants after cardiopulmonary bypass. Pediatr Crit Care Med. 2010;11(2):234-8.9.Weingart S. Push-dose pressors for immediate blood pressure control. Clin Exp Emerg Med. 2015;2(2):131-2.10.Petersson U, Acosta S, Bjorck M. Vacuum-assisted wound closure and mesh-mediated fascial traction--a novel technique for late closure of the open abdomen. World journal of surgery. 2007;31(11):2133-7.11.Mukhi AN, Minor S. Management of the open abdomen using combination therapy with ABRA and ABThera systems. Can J Surg. 2014;57(5):314-9.12.Weaver JL, Matheson PJ, Matheson A, Graham V, Harbrecht BG, Downard CD, et al. Direct peritoneal resuscitation reduces intestinal permeability after brain death. J Trauma Acute Care Surg. 2018;84(2):265-72.13.Smith JW, Ghazi CA, Cain BC, Hurt RT, Garrison RN, Matheson PJ. Direct peritoneal resuscitation improves inflammation, liver blood flow, and pulmonary edema in a rat model of acute brain death. J Am Coll Surg. 2014;219(1):79-87.14.Kirkpatrick AW, Roberts DJ, De Waele J, Jaeschke R, Malbrain ML, De Keulenaer B, et al. Intra-abdominal hypertension and the abdominal compartment syndrome: updated consensus definitions and clinical practice guidelines from the World Society of the Abdominal Compartment Syndrome. Intensive care medicine. 2013;39(7):1190-206. ................
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