Quality Improvement of Damage Control Laparotomy: Impact of the Establishment of a Single Korean Regional Trauma Center

Abstract

Background Damage control laparotomy (DCL) is a lifesaving technique to minimize the lethal triad of coagulopathy, hypothermia, and acidosis. The government has nominated and supported our center as one of the regional trauma centers of South Korea since 2014. This study aimed to investigate the improving outcomes of patients undergoing DCL before and after the establishment of the trauma center. Method The period from January 2011 to December 2017 was divided into pre‐trauma center (pre‐TC) (2011–2013) and trauma center (TC) (2014–2017) periods. Multivariable logistic regression was performed to identify the risk factors and risk‐adjusted cumulative sum (RA‐CUSUM), and graphs were used to monitor the change in mortality. Result Of the 485 patients who underwent trauma laparotomy, DCL was performed for 119 patients (24.5%). The operation time (99 vs. 80 min, p = 0.022), time from admission to operation (125 vs. 112 min, p = 0.010), time from admission to first treatment (119 vs. 99 min, p = 0.004), and time from admission to first transfusion (70 vs. 52 min, p = 0.009) were significantly shortened in the TC period. The ratio of plasma to packed red blood cells in massive transfusions (≥PRBCs 10 units within the first 24 h) was significantly increased in the TC period (0.56 vs. 0.72, p = 0.004). RA‐CUSUM curves revealed that the risk‐adjusted 30‐day mortality improved and then plateaued in the TC period. Conclusion After the implementation of a trauma center, more prompt intervention and damage control resuscitation could be achieved. Moreover, risk‐adjusted mortality of DCL was improved.

Quality monitoring of resuscitative endovascular balloon occlusion of the aorta using cumulative sum analysis in Korea: a case series

“…Sixth, we could not perform risk-adjusted CUSUM analysis because of the small sample size. In a previous study, a risk-adjusted CUSUM methodology was used to adjust for individual risk and minimize selection bias based on a multivariable logistic regression model [9,11]. However, such models are statistically unstable when the sample size is small [14].…”

“…The CUSUM procedure is a graphical method that is widely used for quality monitoring [9][10][11]. In this study, the CUSUM was calculated as follows: S n = (X i -p 0i ), where S n is the summation of the score, X i = 0 for success (for example, patient survival) and X i = 1 for failure (for example, patient death), and p 0i denotes the predicted probability of failure of the procedure.…”

“…However, the learning curve associated with REBOA has not been examined in previous studies. Recently, the learning curve for damage control laparotomy in a Korean regional trauma center was evaluated using cumulative sum (CUSUM) analysis, which is a useful method for monitoring the performance of procedures [9][10][11]. Here, we investigated the improvement in the quality of the REBOA procedure and associated mortality using CUSUM at the hospital level.…”

Clinical Outcomes of Emergent Laparotomies in Hypotensive Patients: 9-years Experience at a Single Level 1 Trauma Center

“…Among the deceased group, more than half of the patients died within a day after the laparotomy, and most of these deaths occurred within 5 hours. Hemorrhages are the leading cause of death following trauma, so emphasis is on early hemorrhagic control [5,8]. However, the debate as to whether time to laparotomy is an important factor for survival is ongoing.…”