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Improving mortality in trauma laparotomy through the evolution of damage control resuscitation: Analysis of 1,030 consecutive trauma laparotomies

Joseph, Bellal MD; Azim, Asad MD; Zangbar, Bardiya MD; Bauman, Zachary MD; O'Keeffe, Terence MD; Ibraheem, Kareem MD; Kulvatunyou, Narong MD; Tang, Andrew MD; Latifi, Riaft MD; Rhee, Peter MD

Journal of Trauma and Acute Care Surgery: February 2017 - Volume 82 - Issue 2 - p 328–333
doi: 10.1097/TA.0000000000001273
Original Articles
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BACKGROUND The aim of this study was to evaluate the related change in outcomes (mortality, complications) in patients undergoing trauma laparotomy (TL) with the implementation of damage control resuscitation (DCR). We hypothesized that the implementation of DCR in patients undergoing TL is associated with better outcomes.

METHODS We analyzed 1,030 consecutive patients with TL. Patients were stratified into three phases: pre-DCR (2006–2007), transient (2008–2009), and post-DCR (2010–2013). Resuscitation fluids (crystalloids and blood products), injury severity score (ISS), vital signs, and laboratory (hemoglobin, international normalized ratio, lactate) parameters were recorded. Regression analysis was performed after adjusting for age, ISS, laboratory and vital parameters, comorbidities, and resuscitation fluids to identify independent predictors for outcomes in each phase.

RESULTS Patient demographics and ISS remained the same throughout the three phases. There was a significant reduction in the volume of crystalloid (p = 0.001) and a concomitant increase in the blood product resuscitation (p = 0.04) in the post-DCR phase compared to the pre-DCR and transient DCR phases. Volume of crystalloid resuscitation was an independent predictor of mortality in the pre-DCR (OR [95% CI]: 1.071 [1.03–1.1], p = 0.01) and transient (OR [95% CI]: 1.05 [1.01–1.14], p = 0.01) phases; however, it was not associated with mortality in the post-DCR phase (OR [95% CI]:1.01 [0.96–1.09], p = 0.1). Coagulopathy (p = 0.01) and acidosis (p = 0.02) were independently associated with mortality in all three phases.

CONCLUSION The implementation of DCR was associated with improved outcome in patients undergoing TL. There was a decrease in the use of damage control laparotomy, with a decrease in the use of crystalloid and an increase in the use of blood products.

LEVEL OF EVIDENCE Prognostic study, level III.

From the Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery (B. J., A. A., B. Z., Z. M. B., T. O., K. I., N. K., A. T., R. L., P. R.), University of Arizona, Tucson, Arizona.

Submitted: May 3, 2016, Revised: July 25, 2016, Accepted: August 22, 2016, Published online: October 31, 2016.

This study was presented at the 123rd annual meeting of the Western Surgical Association, November 7–10, 2015, in Napa Valley, California.

Address for reprints: Bellal Joseph, MD, Division of Trauma, Critical Care, and Emergency Surgery, Department of Surgery, University of Arizona, 1501 N. Campbell Ave., Room 5411, P.O. Box 245063, Tucson, AZ 85724; email: bjoseph@surgery.arizona.edu.

© 2017 Lippincott Williams & Wilkins, Inc.