Complications after laparotomy for trauma: a retrospective analysis in a level I trauma centre

Gool, Matthijs H. van; Giannakópoulos, Georgios F.; Geeraedts, L.M.G.; Klerk, Elly S.M. de Lange–de; Zuidema, Wietse P.

doi:10.1007/s00423-014-1260-0

Cited by 19 publications

(25 citation statements)

References 40 publications

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“…In addition, the use of larger volumes of intraoperative peritoneal irrigation render no additional benefit for the prevention of intraabdominal sepsis, wound complications (including wound infections and evisceration episodes), or anastomotic dehiscence and enterocutaneous fistula formation events. This is also in line with the most current literature on the subject [41][42][43][44][45][46][47][48][49][50].…”

Section: Discussionsupporting

confidence: 91%

“…While there is experimental evidence of at least one benefit to the use of irrigation in trauma victims [39], our results strongly suggest an upper limit of 5L for the effluent. This has relevance for today's practice, since epidemiological evidence exist for the current use of Intraoperative Peritoneal Lavage for this indication in surgical practice [41][42][43][44][45][46][47][48][49][50]. Our trial has several limitations: Since damage control techniques were utilized when indicated (as per the contemporary accepted standard of care) it is very possible that the potential benefits and/or harms (or lack thereof) that the intervention has in this population remain unknown.…”

Section: Discussionmentioning

confidence: 99%

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A Randomized Controlled Trial on Intra-Abdominal Irrigation during Emergency Trauma Laparotomy; Time for Yet Another Paradigm Shift

Mashbari

Hemdi

Chow

et al. 2018

BEAT

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Objective: To determine the optimal volume of abdominal irrigation that will prevent surgical site infections (both deep and superficial), eviscerations and fistula formations; and improve 30-day mortality in trauma patients. Methods:We conducted a three-arm parallel clinical superiority randomized controlled trial comparing different volumes of effluent (5, 10 and 20 liters) used in trauma patients (both blunt and penetrating) age 14 and above undergoing an emergency laparotomy between April 2002 and July 2004 in a busy urban Level 1 trauma center. Results: After randomization, a total of 204 patients were analyzed. All patient groups were comparable with respect to age, gender distribution, admission injury severity score, and mechanism of injury, estimated blood loss and degree of contamination. The mortality rate overall was 1.96% (4/204).No differences were noted with respect to contamination, wound infection, fistula formation, and evisceration. The twenty liter group (Group III) showed a trend toward an increased incidence of deep surgical site infections when compared to the five liter (Group I) (p=0.051) and ten liter (Group II) (p=0.057) groups. This did not however reach statistical significance. Conclusion: The old surgical adage "the solution to pollution is dilution" is not applicable to trauma patients. Our results suggest that using more irrigation, even when large amounts of contamination have occurred, does not reduce post-operative complications or affect mortality; and it may predispose patients to increased incidence of abscess formation. (Trial registration number: ISRCTN66454589)

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

A Randomized Controlled Trial on Intra-Abdominal Irrigation during Emergency Trauma Laparotomy; Time for Yet Another Paradigm Shift

Mashbari

Hemdi

Chow

et al. 2018

BEAT

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“…In the past decades, it is suggested that the exposure of most European surgeons to an emergency laparotomy in severely injured patients is declining [1]. Penetrating injuries are a frequent indication for laparotomy in trauma patients [2,3]. However, in most European countries, penetrating injuries are a rare phenomenon.…”

Section: Introductionmentioning

confidence: 99%

Outcome of trauma-related emergency laparotomies, in an era of far-reaching specialization

et al. 2019

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Background: Far reaching sub-specialization tends to become obligatory for surgeons in most Western countries. It is suggested that exposure of surgeons to emergency laparotomy after trauma is ever declining. Therefore, it can be questioned whether a generalist (i.e., general surgery) with additional differentiation such as the trauma surgeon, will still be needed and can remain sufficiently qualified. This study aimed to evaluate volume trends and outcomes of emergency laparotomies in trauma. Methods: A retrospective cohort study was performed in the University Medical Center Utrecht between January 2008 and January 2018, in which all patients who underwent an emergency laparotomy for trauma were included. Collected data were demographics, trauma-related characteristics, and number of (planned and unplanned) laparotomies with their indications. Primary outcome was in-hospital mortality; secondary outcomes were complications, length of ICU, and overall hospital stay. Results: A total of 268 index emergency laparotomies were evaluated. Total number of patients who presented with an abdominal AIS > 2 remained constant over the past 10 years, as did the percentage of patients that required an emergency laparotomy. Most were polytrauma patients with a mean ISS = 27.5 (SD ± 14.9). The most frequent indication for laparotomy was hemodynamic instability or ongoing blood loss (44%).Unplanned relaparotomies occurred in 21% of the patients, mostly due to relapse of bleeding. Other complications were anastomotic leakage (8.6%), intestinal leakage after bowel contusion (4%). In addition, an incisional hernia was found in 6.3%. Mortality rate was 16.7%, mostly due to neurologic origin (42%). Average length of stay was 16 days with an ICU stay of 5 days. Conclusion: This study shows a persistent number of patients requiring emergency laparotomy after (blunt) abdominal trauma over 10 years in a European trauma center. When performed by a dedicated trauma team, this results in acceptable mortality and complication rates in this severely injured population.

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“…Some investigators have reported Clavien-Dindo complication scores following trauma 10–12 but without an explanation regarding how any modifications were made or whether there were any issues with translating the scoring system from elective surgery to emergency trauma management. Furthermore, they do not cite any source or justification for their utilization of Clavien-Dindo.…”

Section: Discussionmentioning

confidence: 99%

An adapted Clavien-Dindo scoring system in trauma as a clinically meaningful nonmortality endpoint

Naumann

Vincent

Pearson

et al. 2017

Journal of Trauma and Acute Care Surgery

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Background There is no consensus on reporting non-mortality trauma complications in a graded manner. The Clavien-Dindo scale of complications was originally for elective surgery, and requires adaptation to provide meaningful data for trauma patients. In particular the original score does not account for those treated without surgery. We report an adapted Clavien-Dindo in trauma (ACDiT) scale and apply it to patients managed operatively and non-operatively. Methods A combined prospective and retrospective international multi-center observational study was undertaken to apply the ACDiT scale to 484 trauma patients at 3 university teaching hospitals (Birmingham, England (n=303); Houston, Texas (n=113); and Glasgow, Scotland (n=68)). These included both intensive care (ICU) and non-ICU managed patients. The Clavien-Dindo scoring system was adapted for trauma patients based on consensus amongst an international collaboration of trauma specialists at these sites. Data included whether initial patients were managed operatively or non-operatively. Complication grades were compared to hospital-free and ICU-free days as other outcome measures of patient morbidity. Results 217/484 (44.8%) patients experienced complications, of whom 61/217 (28.1%) died (Grade V). The remainder consisted of grades I (n=20), II (n=60), III (n=24) and IV (n=52). There was a strong association between higher ACDiT grade category and lower number of hospital-free and ICU-free days (p<0.01). Eighty-eight patients with complications did not require surgery, validating the score’s usefulness in patients managed non-operatively. Conclusions The ACDiT scale can be used to grade the severity of post-trauma complications in patients managed both operatively and non-operatively. It provides clinically meaningful data for morbidity and mortality meetings and other quality improvement exercises.

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Complications after laparotomy for trauma: a retrospective analysis in a level I trauma centre

Abstract: Laparotomy for trauma has a high complication rate resulting in significant morbidity and mortality. Most events occur in the early postoperative period. Further prospective research needs to be conducted in order to identify possibilities to improve care in the future.

Cited by 19 publications

References 40 publications

A Randomized Controlled Trial on Intra-Abdominal Irrigation during Emergency Trauma Laparotomy; Time for Yet Another Paradigm Shift

A Randomized Controlled Trial on Intra-Abdominal Irrigation during Emergency Trauma Laparotomy; Time for Yet Another Paradigm Shift

Outcome of trauma-related emergency laparotomies, in an era of far-reaching specialization

An adapted Clavien-Dindo scoring system in trauma as a clinically meaningful nonmortality endpoint

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