The effect of damage control laparotomy on major abdominal complications: A matched analysis

George, Mitchell J.; Adams, Sasha D.; McNutt, Michelle K.; Love, Joseph D.; Albarado, Rondel; Moore, Laura J.; Wade, Charles E.; Cotton, Bryan A.; Holcomb, John B.; Harvin, John A.

doi:10.1016/j.amjsurg.2017.10.044

Cited by 30 publications

(25 citation statements)

References 19 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: 79%

“…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: 79%

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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“…Thus, PSC may still be utilized with success in patients undergoing DCS. However, caution must be taken with this interpretation given the increased risk of complications with delayed abdominal closure [ 36 ].…”

Section: Discussionmentioning

confidence: 99%

“…This recommendation must acknowledge that these patients demonstrated less injury burden in comparison to others within our study. Concern for overuse of DCS has previously been raised and fervor for the procedure should be tempered with the knowledge that the risk of complications for patients managed with TAC is greater for those who may undergo definitive closure at the initial operation [ 36 , 48 ]. Use of vacuum-assisted dressings continues to be the preferred method for TAC in DCS for trauma.…”

Section: Discussionmentioning

confidence: 99%

Impact of initial temporary abdominal closure in damage control surgery: a retrospective analysis

Uhlich

Gleason

et al. 2018

World J Emerg Surg

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BackgroundDamage control surgery has revolutionized trauma surgery. Use of damage control surgery allows for resuscitation and reversal of coagulopathy at the risk of loss of abdominal domain and intra-abdominal complications. Temporary abdominal closure is possible with multiple techniques, the choice of which may affect ability to achieve primary fascial closure and further complication.MethodsA retrospective analysis of all trauma patients requiring damage control laparotomy upon admission to an ACS-verified level one trauma center from 2011 to 2016 was performed. Demographic and clinical data including ability and time to attain primary fascial closure, as well as complication rates, were recorded. The primary outcome measure was ability to achieve primary fascial closure during initial hospitalization.ResultsTwo hundred and thirty-nine patients met criteria for inclusion. Primary skin closure (57.7%), ABThera™ VAC system (ABT) (15.1%), Bogota bag (BB) (25.1%), or a modified Barker’s vacuum-packing (BVP) (2.1%) were used in the initial laparotomy. Patients receiving skin-only closure had significantly higher rates of primary fascial closure and lower hospital mortality, but also significantly lower mean lactate, base deficit, and requirement for massive transfusion. Between ABT or BB, use of ABT was associated with increased rates of fascial closure. Multivariate regression revealed primary skin closure to be significantly associated with primary fascial closure while BB was associated with failure to achieve fascial closure.ConclusionsPrimary skin closure is a viable option in the initial management of the open abdomen, although these patients demonstrated less injury burden in our study. Use of vacuum-assisted dressings continues to be the preferred method for temporary abdominal closure in damage control surgery for trauma.

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“…(1, 2) However, DCL has been associated with many complications and current use of DCL varies widely between institutions. (3)(4)(5)(6) This variation is likely due to a lack of consensus on the indications for the use of DCL. (7)(8)(9) In addition to a lack of consensus for various indications, the ideal DCL rate is unknown.…”

Section: Introductionmentioning

confidence: 99%

Better understanding the utilization of damage control laparotomy: A multi-institutional quality improvement project

Harvin¹,

Sharpe

Croce

et al. 2019

J Trauma Acute Care Surg

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Background: Rates of damage control laparotomy (DCL) vary widely and consensus on appropriate indications does not exist. The purposes of this multi-center quality improvement (QI) project were to decrease the use of DCL and to identify indications where consensus exists. Methods: In 2016, six US Level 1 trauma centers performed a year-long, QI project utilizing a single QI tool: audit and feedback. Each emergent trauma laparotomy was prospectively reviewed. DCL cases were adjudicated based upon majority vote of faculty members as being appropriate or potentially, in retrospect, safe for definitive laparotomy. The rate of DCL for two years prior (2014 and 2015) was retrospectively collected and used as a control. To account for secular trends of DCL, interrupted time series was used to effectiveness of the QI interventions.

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The effect of damage control laparotomy on major abdominal complications: A matched analysis

Cited by 30 publications

References 19 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

Impact of initial temporary abdominal closure in damage control surgery: a retrospective analysis

Better understanding the utilization of damage control laparotomy: A multi-institutional quality improvement project

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