Abdominal hypertension is a pathologic elevation in intraabdominal pressure most often seen in critically ill patients with propensity for progression to abdominal compartment syndrome once organ dysfunction develops. Intraabdominal hypertension alone is an independent predictor of morbidity and mortality, but progression to abdominal compartment syndrome portends a worse prognosis with extremely high mortality rates, even after treatment. Pathologic increases in intraabdominal pressure can cause physiologic changes impacting multiple organ systems both directly and indirectly, which may lead to rapid patient deterioration. As such, critical care providers must be able to identify high risk patients in order to effectively monitor intraabdominal pressure and to provide expeditious, appropriate treatment for these patients when warranted. While the diagnosis of abdominal compartment syndrome is clinical, the sensitivity of physical examination alone is low, and at risk patients should undergo intraabdominal pressure monitoring with bladder pressures measured every 4 hours. Changes in intraabdominal pressure or organ function and the time over which these changes develop dictate treatment choice. Management strategies for intraabdominal hypertension focus on reduction of intraabdominal volume, increasing abdominal wall compliance, and optimizing fluid balance, which is a nuanced practice in critically ill patients. There are a multitude of treatment options which may be employed to address the spectrum of intraabdominal hypertension, which ranges from asymptomatic elevations in intraabdominal pressure to overt abdominal compartment syndrome requiring emergent decompression. The step-up management approach suggests beginning with less invasive supportive and medical therapies and escalating as appropriate to procedural, then surgical interventions if necessary to reduce pathologically elevated intraabdominal pressure. To improve patient outcomes, critical care providers must be adept at identifying patients requiring intraabdominal pressure monitoring, recognizing and addressing physiologic changes associated with intraabdominal hypertension, and managing the condition effectively to prevent the potentially catastrophic consequences of abdominal compartment syndrome.

Background/Objectives: Colorectal surgeons continue to care for an aging cancer population with increasing comorbidities and frailty. Frailty, characterized by a systemic physiologic decline associated with aging, is an increasingly popular focus in surgical outcomes research. This retrospective study investigates how frailty impacts outcomes in the octogenarian and nonagenarian populations undergoing surgical treatment for colon cancer. Methods: Data from the National Surgical Quality Improvement Program (NSQIP) colectomy-targeted variables dataset from 2015 to 2021 were utilized for this analysis, including patients 80 years of age and older. Frailty was assessed using the five-factor modified frailty index (mFI-5). The study examined post-operative outcomes across frailty groups in this population. Results: From 2015–2021, there were 10,671 patients aged 80 years and older who underwent colectomy for colon cancer, of whom 1259 (11.8%) were 90 years or older and 2844 (26.7%) were severely frail. Frailty significantly impacted post-operative colectomy outcomes in this population. On univariate analysis, frail patients had higher rates of pneumonia (p = 0.015), unplanned intubation (p = 0.012), stroke (p < 0.001), myocardial infarction (p = 0.011), readmission (p < 0.001), long length of stay (p < 0.001), and mortality (p < 0.001) compared to non-frail patients. On multivariate analysis, severe frailty (mFI-5 of 2 or more) was associated with an increased odds of unplanned intubation (aOR 2.41, 95% CI 1.27–4.59), long length of stay (aOR 1.73, 95% CI 1.44–2.09), readmission (aOR 1.84, 95% CI 1.42–2.39), and mortality (aOR 1.95, 95% CI 1.20–3.15) compared to non-frail patients. Conclusions: Frailty plays a critical role in influencing the outcomes of octogenarians and nonagenarians undergoing colectomy for colon cancer within the NSQIP dataset. Future work should investigate whether addressing frailty prior to surgery in this population can improve patients’ post-operative courses.

INTRODUCTION: Fibrinogen supplementation (FS) is commonly achieved with cryoprecipitate, although the required on-demand thawing often results in delayed FS. Pathogen-reduced cryoprecipitated fibrinogen complex (INTERCEPT fibrinogen complex [IFC]), a novel product, can be stored thawed for up to 5 days, allowing for immediate availability. We hypothesized that IFC implementation at our level 1 trauma center would be associated with increased likelihood of FS, decreased mortality, and transfusion requirement (TR). METHODS: This was a retrospective review from a single level 1 trauma center from 2022 to 2024, spanning 1 year pre- and post-IFC implementation. Adults who received >900 mL of red blood cells and/or whole blood (WB) within 1 hour were included to identify patients who reached critical administration threshold, indicating significant hemorrhage, without excluding those being resuscitated primarily with WB. Multiple logistic regression assessed the independent effect of IFC implementation on the likelihood of FS and 24-hour mortality. Linear regression modeled TR. RESULTS: In 294 included patients, 24.1% received FS (21.4% pre-IFC, 26.6% post-IFC, p = 0.299). Post-IFC patients tended to be older (44 vs. 39, p = 0.011) and had blunt trauma more often (67.5% vs. 53.6%, p = 0.009), lower shock index (0.87 vs. 0.99, p = 0.004), higher rates of WB use (72.1% vs. 37.9%, p < 0.001), and lower 4-hour TR (2.0 vs. 2.4 L, p = 0.027) but similar ISS, GCS, base deficit, and hematocrit. After controlling for these differences, IFC implementation was associated with increased likelihood of FS (adjusted odds ratio, 2.45; 95% confidence interval, 1.05–5.74), but not with 24-hour mortality or 4-hour TR. Although not statistically significant, there was a trend to earlier FS (median, 67 vs. 42 minutes; p = 0.070; rates of FS within 60 minutes, 40.0% vs. 63.4%; p = 0.051). CONCLUSION: INTERCEPT fibrinogen complex implementation at our level 1 trauma center was independently associated with FS, but not mortality or TR. Hemorrhaging patients with hypofibrinogenemia, a time-sensitive predictor of mortality in trauma, may benefit from IFC. LEVEL OF EVIDENCE: Prognostic and Epidemiological; Level III.