Control the damage: morbidity and mortality after emergent trauma laparotomy - 20/06/16
, Curtis J. Wray, M.D., Joshua Steward, B.A., Ryan A. Lawless, M.D., Michelle K. McNutt, M.D., Joseph D. Love, D.O., Laura J. Moore, M.D., Charles E. Wade, Ph.D., Bryan A. Cotton, M.D., M.P.H., John B. Holcomb, M.D.Abstract |
Background |
Damage control laparotomy (DCL) is performed for physiologically deranged patients. Recent studies suggest overutilization of DCL, which may be associated with potentially iatrogenic complications.
Methods |
We conducted a retrospective study of trauma patients over a 2-year period that underwent an emergent laparotomy and received preoperative blood products. The group was divided into definitive laparotomy and DCL.
Results |
A total of 237 received were included: 78 in definitive laparotomy group, 144 in the DCL group, and 15 who died in the operating room. The DCL group was more severely injured and required more transfusions. After propensity score matching, DCL was associated with an 18% increase in hospital mortality, a 13% increase in ileus, and a 7% increase in enteric suture line failure, an 11% increase in fascial dehiscence, and a 19% increase in superficial surgical site infection.
Conclusions |
The potential overuse of DCL unnecessarily exposes patients to increased morbidity and mortality.
Le texte complet de cet article est disponible en PDF.Highlights |
• | In bleeding patients, damage control laparotomy (DCL) can be life-saving. |
• | In this cohort of bleeding patients, DCL appears overused. |
• | DCL is associated with an increase in multiple complications. |
• | DCL is associated with an 18% increase in mortality. |
• | Overutilization of DCL exposes patients to potentially iatrogenic complications. |
Keywords : Damage control laparotomy, Complications, Morbidity, Mortality, Trauma
Plan
| There were no relevant financial relationships or any sources of support in the form of grants, equipment, or drugs. |
|
| The authors declare no conflicts of interest. |
Vol 212 - N° 1
P. 34-39 - juillet 2016 Retour au numéro
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