Damage Control Laparotomy: High‐Volume Centers Display Similar Mortality Rates Despite Differences in Country Income Level

Abstract

Background Comprehensive analysis of trauma care between high-, middle-, and low-income countries (HIC/MIC/ LIC) is needed to improve global health. Comparison of HIC and MIC outcomes after damage control laparotomy (DCL) for patients is unknown. We evaluated DCL utilization among patients treated at high-volume trauma centers in the USA and South Africa, an MIC, hypothesizing similar mortality outcomes despite differences in resources and setting. Methods Post hoc analysis of prospectively collected trauma databases from participating centers was performed. Injury severity, physiologic, operative data and post-operative outcomes were abstracted. Univariate and multivariable analyses were performed to assess differences between HIC/MIC for the primary outcome of mortality. Results There were 967 HIC and 602 MIC patients who underwent laparotomy. DCL occurred in 144 MIC patients (25%) and 241 HIC (24%) patients. Most sustained (58%) penetrating trauma with higher rates in the MIC compared to the HIC (71 vs. 32%, p = 0.001). Between groups, no differences were found for admission physiology, coagulopathy, or markers of shock except for increased presence of hypotension among patients in the HIC. Crystalloid infusion volumes were greater among MIC patients, and MIC patients received fewer blood products than those in the HIC. Overall mortality was 30% with similar rates between groups (29 in HIC vs. 33% in MIC, p = 0.4). On regression, base excess and penetrating injury were independent predictors of mortality but not patient residential status. Conclusion Use and survival of DCL for patients with severe abdominal trauma was similar between trauma centers in HIC and MIC settings despite increased penetrating trauma and less transfusion in the MIC center. While the results overall suggest no gap in care for patients requiring DCL in this MIC, it highlights improvements that can be made in damage control resuscitation.

Definitive hemostasis versus damage control laparotomy for traumatic massive hemoperitoneum with hemodynamic instability: A single-center, propensity score-matched analysis

“…In absolute terms, DH potentially has a greater hemostatic effect than DCL. reported that the in-hospital mortality rate of patients who underwent DCL in high-income countries was 29% (12). Even though these studies excluded patients with cardiac arrest on admission or intra-operative death, the present outcomes including patients with cardiac arrest or intra-operative death were superior to these reports.…”

Primary Definitive Hemostasis for Traumatic Massive Hemoperitoneum With Hemodynamic Instability Improves Outcomes: A Single-Center, Propensity Score-Matched Analysis

“…In 2017, Harvin et al reported that the mortality rate of hypotensive trauma patients undergoing emergent laparotomy was 46% (11). In 2020, Traynor et al reported that the in-hospital mortality rate of patients who underwent DCL in high-income countries was 29% (12). Even though these studies excluded patients with cardiac arrest on admission or intra-operative death, the present outcomes including patients with cardiac arrest or intra-operative death were superior to these reports.…”

Single-staged laparotomy versus multiple-staged laparotomy for traumatic massive hemoperitoneum with hemodynamic instability: a single-center, propensity score-matched analysis

“…In 2017, Harvin et al reported that the mortality rate of hypotensive trauma patients undergoing emergent laparotomy was 46% [ 10 ]. In 2020, Traynor et al reported that the in-hospital mortality rate of patients who underwent DCS in high-income countries was 29% [ 11 ]. Even though these studies excluded patients with cardiac arrest on admission or intra-operative death, the present outcomes including patients with cardiac arrest or intra-operative death were superior to these reports.…”