Between March 2007 and May 2010, 265 consecutive patients with IAH/ACS were managed using OAD in our institution. We retrospectively identified an additional 31 consecutive patients during the same time period who were managed with PCD. The patients receiving PCD were evenly distributed through the study period as follows: 2007, six patients; 2008, eight patients; 2009, 11 patients; and 2010, six patients. The demographics of the 31 patients receiving PCD and 31 disease and severity of illness-matched patients receiving OAD, derived from the 265 patients receiving OAD, are shown in Table 1. The etiology of the patients’ critical illnesses included trauma (23%); general, vascular, or oncologic surgery (36%); burns (29%); and sepsis or multiorgan failure (12%). The two study cohorts were well matched, varying only in the relative indications for decompression. Patients receiving PCD were significantly more likely to undergo decompression for elevated IAP, whereas patients receiving OAD were more likely to undergo decompression for the purposes of damage-control laparotomy. The incidence of ACS was similar in both groups, but there was a nonsignificant trend toward more secondary ACS (64% vs 48%; P = .39) in the PCD cohort. Only one patient in the OAD cohort developed recurrent ACS. Among burn patients receiving PCD, the severity of burn injury was 49% ± 19% total body surface area, with 89% sustaining chest, 56% abdominal, and 56% pulmonary or inhalation injury. Among burn patients undergoing OAD, the severity of burn injury was 42% ± 21% total body surface area, with 78% sustaining chest, 56% abdominal, and 33% pulmonary or inhalation injury (P = .46).