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

Abstract

BackgroundCurrently, damage control laparotomy (DCL) is a standard operative approach for traumatic massive hemoperitoneum with hemodynamic instability. However, we have often observed unsatisfactory hemostatic effects of DCL for severe abdominal traumas, requiring definitive hemostasis (DH). We hypothesized that primary DH could improve the outcomes of hemodynamically unstable patients with traumatic massive hemoperitoneum compared with DCL.MethodsThis retrospective, single-center, observational study evaluated hemodynamically unstable patients with traumatic massive hemoperitoneum requiring surgical intervention between 2005 and 2020. The patient population was divided into two groups: a DH group and a DCL group. Propensity score matching was used to adjust for differences in baseline characteristics in the two groups, a one-to-one matched analysis using nearest-neighbor matching was performed based on the estimated propensity score of each group. The primary outcome was in-hospital mortality, and secondary outcomes were 48-hour mortality and 28-day mortality.ResultsA total of 170 patients met the inclusion criteria; 141 patients underwent primary DH, and 29 underwent DCL. In the propensity-matched analysis with 27 pairs, the DH group had significantly lower in-hospital mortality (odds ratio [OR] 0.154; 95% confidence interval (CI) 0.035 to 0.682) and 28-day mortality (OR 0.200; 95% CI 0.044 to 0.913) than the DCL group, but the 48-hour mortality did not differ significantly between the two groups (25.9% vs. 44.4%; OR 0.375; 95% CI 0.099-1.414). ConclusionsPrimary DH is an effective surgical procedure for traumatic massive hemoperitoneum with hemodynamic instability. Primary DH can be the standard surgical intervention for severe abdominal trauma.