Damage control laparotomy: A vital tool once overused

Guillermo Higa, Randall Friese, Terence O'Keeffe, Julie Wynne, Paul Bowlby, Michelle Ziemba, Rifat Latifi, Narong Kulvatunyou, Peter Rhee

Research output: Contribution to journalArticle

65 Scopus citations

Abstract

Background: Trauma surgery is in constant evolution as is the use of damage control laparotomy (DCL). The purpose of this study was to report the change in usage of DCL over time and its effect on outcome. Methods: Trauma patients requiring laparotomies during a 3-year (2006-2008) period were reviewed. DCL was defined as laparotomy when fascia was not closed at the first operation. Results: There were 14,534 trauma patients evaluated, and 843 laparotomies were performed on 532 patients during the study period. The number of patients requiring open laparotomies slightly increased while the demographics and Injury Severity Score were similar during the study period. The number of patient requiring DCL significantly decreased from 36.3% (53 of 146) in 2006 to 8.8% (15 of 170) in 2008 (p < 0.001). During this same time period, the mortality rate for patients requiring open laparotomy significantly decreased from 21.9% in 2006 to 12.9% in 2008 (p = 0.05). The decreased use of DCL resulted in a 33.3% reduction in the number of laparotomies performed. The decrease in average costs and charges is projected to result in savings of $2.2 million and $5.8 million, respectively. Conclusions: The use of DCL was significantly decreased by 78% during the study with significantly improved outcome. The improved outcome and decreased resource utilization can reduce health care costs and charges. Although DCL may be a vital aspect of trauma surgery, it can be used more selectively with improved outcome.

Original languageEnglish (US)
Pages (from-to)53-59
Number of pages7
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume69
Issue number1
DOIs
StatePublished - Jul 1 2010

Keywords

  • Abdominal compartment syndrome
  • Bleeding
  • Cost
  • Damage control
  • Laparotomy
  • Mortality
  • Resuscitation
  • Shock
  • Surgery
  • Trauma

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

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