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A Saline/Bipolar Radiofrequency Energy Device As an Adjunct for Hemostasis in Solid Organ Injury/Trauma

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Published on: July 28, 2020

Delayed interventions and mortality in trauma damage control laparotomy.

Margaret H Lauerman¹, Joseph Dubose², Kyle Cunningham¹

¹Division of Trauma and Critical Care, R Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, MD.

|August 9, 2016

Summary

This summary is machine-generated.

Delayed interventions in damage control laparotomy are common. While overall outcomes were similar, delayed vascular repair and emergent re-exploration significantly increased mortality in trauma patients.

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Area of Science:

Trauma surgery
Surgical critical care
Abdominal surgery

Background:

Damage control laparotomy (DCL) is a critical surgical approach for severely injured patients.
Key principles of DCL include controlling hemorrhage and contamination.
The optimal timing and necessity of initial DCL components remain unclear, with potential delays in definitive repair.

Purpose of the Study:

To determine the frequency of delayed interventions in damage control laparotomy.
To evaluate the impact of these delayed interventions on patient outcomes.
To identify specific scenarios where delayed interventions are associated with increased morbidity and mortality.

Main Methods:

Retrospective review of 330 patients who underwent damage control laparotomy and survived to reoperation.
Interventions performed at the second laparotomy were classified as delayed.
Analysis of outcomes including mortality, intra-abdominal infection, anastomotic leak, and fistula formation.

Main Results:

13.9% of all interventions were first performed at the second laparotomy, including 27.2% of vascular interventions.
Delayed interventions overall did not significantly increase mortality or infectious complications.
However, delayed vascular interventions and unplanned re-explorations for hemorrhage control were associated with significantly increased mortality.

Conclusions:

Delayed interventions are frequent in damage control laparotomy, often involving multiple surgical stages.
While not universally detrimental, delayed repair of major vascular injuries and emergent re-explorations are linked to higher mortality.
Consideration should be given to addressing injuries more comprehensively during the initial damage control laparotomy to potentially improve outcomes.