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Damage Control Surgery for Non-traumatic Abdominal Emergencies.

Edouard Girard1,2,3, Julio Abba4, Bastien Boussat5,6

  • 1Digestive and Emergency Surgery Department, Grenoble-Alpes University Hospital, Grenoble, France. egirard1@chu-grenoble.fr.

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Summary

Damage control surgery (DCS) is lifesaving for critically ill patients with general surgery emergencies. This approach offers a survival benefit, particularly for those with peritonitis and acute pancreatitis.

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Area of Science:

  • Surgical Critical Care
  • General Surgery Outcomes
  • Emergency Medicine

Background:

  • Damage control surgery (DCS) is established in trauma but understudied in general surgery emergencies.
  • Limited data exists on the efficacy and outcomes of DCS in non-traumatic abdominal conditions.

Purpose of the Study:

  • To evaluate the outcomes of damage control surgery (DCS) in patients experiencing general surgery emergencies.
  • To assess the survival benefit of DCS in a cohort of critically ill surgical patients.

Main Methods:

  • A retrospective analysis of 164 patients undergoing DCS for non-traumatic abdominal emergencies between 2005 and 2015.
  • DCS criteria included hypotension, hypothermia, acidosis, coagulopathy, and massive transfusion.
  • Outcomes were compared to predicted mortality using established scoring systems (APACHE II, POSSUM, P-POSSUM, SAPS II).

Main Results:

  • DCS was performed for acute mesenteric ischemia, peritonitis, pancreatitis, and bleeding, with 32% experiencing abdominal compartment syndrome.
  • Overall mortality was 45%, with independent predictors of mortality including age and elevated INR (≥1.7).
  • Mortality increased with the number of DCS criteria present, but observed mortality was lower than predicted, indicating a survival benefit.

Conclusions:

  • Damage control surgery (DCS) can be a life-saving intervention for critically ill patients with general surgery emergencies.
  • Patients with peritonitis and acute pancreatitis appear to benefit most from the DCS approach.
  • DCS demonstrates a significant survival benefit compared to predicted outcomes in this patient population.