Trends and clinical outcomes of abdominal compartment syndrome among intensive care hospitalizations.

Abstract

Abdominal compartment syndrome has been shown to be a highly morbid condition among patients admitted to the intensive care unit. The present study sought to characterize trends as well as clinical and financial outcomes of patients with abdominal compartment syndrome. The 2010 to 2020 National Inpatient Sample was used to identify adults (≥18 years) admitted to the intensive care unit. Standard mean differences were obtained to demonstrate effect size with >0.1 denoting significance. Hospitals were divided into tertiles based on annual institutional intensive care unit admissions. Multivariable regression models were used to evaluate the association of abdominal compartment syndrome on outcomes. The primary endpoint was in-hospital mortality, while complications, costs, and length of stay were secondarily considered. Of 11,804,585 patients, 19,644 (0.17%) developed abdominal compartment syndrome. Over the study period, the incidence of abdominal compartment syndrome (2010-0.19%, 2020-0.20%, P < .001) remained similar. Those with abdominal compartment syndrome were more commonly admitted for gastrointestinal (22.8% vs 8.4%) and cardiovascular (22.6% vs 14.9%) etiologies and were more frequently managed at urban teaching hospitals (77.7% vs 65.1%) as well as high-volume intensive care units (85.2% vs 79.1%) (all standard mean differences >0.1). After adjustment, abdominal compartment syndrome was associated with higher odds of mortality (adjusted odds ratio: 3.84, 95% confidence interval: 3.57-4.13, reference: non-abdominal compartment syndrome). Incremental length of stay (β: +5.0 days, 95% confidence interval: 4.2-5.8) and costs (β: $49.3K, 95% confidence interval: 45.3-53.4) were significantly higher in abdominal compartment syndrome compared to non-abdominal compartment syndrome. Abdominal compartment syndrome, while an uncommon occurrence among intensive care unit patients, remains highly morbid with significant resource burden. Further work exploring factors to mitigate its clinical and financial burden is needed.