Experience of damage control trauma laparotomy in a limited resource healthcare setting: A retrospective Cohort Study

Abstract

Introduction Damage control surgery (DCS) is an established option for managing severely injured trauma patients. However, its role in the management of similar patients in the developing world is debatable. The purpose of this study is to describe characteristics and outcomes of patients undergoing DCS. Methods All trauma patients requiring laparotomies from 1996–2011 at a tertiary care hospital in South Asia were reviewed. DCS was defined in a patient who underwent a truncated laparotomy where the fascia was primarily left open, with the intention of physiological optimization in the Intensive Care Unit, followed by definitive surgery. The primary outcome was in-hospital mortality. Multivariate logistic regression was used to determine the independent predictors of mortality after adjustment for potential confounders. Results Of 258 patients, 47 underwent DCS. 40% patients were transferred from other hospitals. The time between injury and operation was 152 minutes (IQR: 90–330). Intra-operative laboratory parameters revealed a median pH of 7.16 (IQR: 7.10–7.27), median temperature of 34.7 (IQR: 34.0–35.4) and median PT of 15.9 (IQR: 12.4–21.2). 55% of the patients survived to discharge from hospital. Of those who died, 86% died before the first take back operation. Packed red blood cell transfusion and vascular injury were independently associated with mortality. Discussion Damage control surgery is feasible in developing countries, with more than 50% survival reported at one hospital. Future research should focus on critical care management. Conclusion Damage Control trauma laparotomy is feasible in tertiary care hospitals with multidisciplinary trauma teams in lesser-developed countries.

Lessons learnt from the Pietermaritzburg experience with damage control laparotomy for trauma

“…Both the demographics and the presenting physiology appear to be similar 2 4 5. There is no significant variation in survivability in our study (2012–2017) (68%) versus the Pakistani group5 (1996–2011) (55%) versus Rotondo et al (USA) (1993) (58%)2; however, Johnson et al (1997–2000)4 have survival rates of 90%. The international consensus that physiological derangement should supersede anatomic consideration is shared in Brazil6 and India 7.…”

Damage Control Surgery – 6 years experiences at a Level 1 Trauma Centre

“…[38] In a nutshell, the entire philosophy of DCS focuses on early control of major hemorrhage and optimization of the physiology, to be followed by staged definitive anatomical or structural repair. [39][40][41][42][43]…”

War surgery in a Turkish hospital near the border of Syria: An evaluation in terms of critical and intensive care treatment principles

“…[4] In a previous study, the criteria adopted for making a DCS decision are ISS >25, systolic blood pressure <70 mmHg, core body temperature <34 °C, and pH <7.1. [14] Only a limited number of DCS cases carried out on individuals injured during the Syrian Civil War have been reported. [15] In our study, 204 patients meeting the criteria were subjected to DCS in our hospital.…”