Prevention of Abdominal Compartment Syndrome in Acute Care Surgery: A Scoping Review of Risk Factors and Management Strategies.

INTRODUCTION: Abdominal compartment syndrome (ACS) is a life-threatening complication of sustained intra-abdominal hypertension (IAH) that can lead to organ dysfunction and substantial morbidity and mortality. Early identification and prevention are critical to limiting progression. This scoping review evaluates risk factors and preventive and therapeutic strategies for ACS in acute care surgical populations. METHODS: This scoping review systematically searched PubMed, Cochrane, and ProQuest, supplemented by a search of the ScienceDirect full-text platform, to identify studies evaluating preventive and early-intervention strategies for ACS in acute care surgery populations through April 2026. RESULTS: Twelve studies were included. Preventive surgical strategies were associated with decreases in intra-abdominal pressure (IAP) and ACS progression. Percutaneous catheter decompression reported a statistically significant decrease in IAP (P = 0.001), whereas prophylactic decompressive laparotomy was associated with a decrease in IAP from 24.4 ± 8.5 mmHg to 13.4 ± 4.0 mmHg (P < 0.0001). Reduced crystalloid resuscitation was associated with a lower incidence of ACS (7.4% in 2006 versus 0% in 2011, P < 0.001) and lower mortality (22.8% versus 10.6%, P < 0.001). Independent risk factors for the development of ACS included abdominal distention (odds ratio [OR]: 4.951, P < 0.001), obesity (body mass index >30; OR: 3.413, P < 0.001), positive fluid balance, and elevated base deficit. Age was the only independent predictor of mortality (OR: 1.09, P = 0.017). Limited evidence suggested early enteral nutrition may reduce the progression of IAH without increasing IAP. CONCLUSIONS: Severe injury burden, prolonged IAH, obesity, abdominal distention, positive fluid balance, and aggressive crystalloid resuscitation were consistently associated with increased ACS risk. Preventive strategies, including balanced resuscitation, routine IAP monitoring, early enteral nutrition, and timely decompressive interventions, were associated with lower ACS incidence and improved outcomes.