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Are Fewer Damage Control Laparotomies Associated with a Decrease in the Rate and Severity of Surgical Site
Stephanie Martinez Ugarte1,2,3, Mokunfayo O Fajemisin1,2,3, Chelsea J Guy-Frank2,3
1Center for Translational Injury Research, Department of Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, Texas, USA.
Background:
Damage control laparotomy (DCL) rates have declined and remained low. Given DCL's association with surgical site infections (SSIs), we hypothesize that SSI rates and severity, as per Clavien-Dindo (CD) classification, have decreased concurrently.
Patients And Methods:
A retrospective study was performed on patients (≥16 y) who underwent trauma laparotomy from January 2011 to December 2020. Patients who survived ≤48 hours were excluded. Data were divided into period 1 (January 2011-December 2015, DCL rates declined) and period 2 (January 2016-December 2020, low DCL rates were sustained). SSIs were defined as per the Centers for Disease Control and Prevention, and severity was graded by the CD scale (I-V). SSIs were classified as minor (CD grade I-II) and major (CD grade III-V). Uni-variable and multi-variable analyses were performed (p < 0.05).
Results:
In total 1,975 patients met the inclusion criteria. Between periods 1 and 2, there was an increase in injury severity score (ISS); (19 [IQR: 10, 29] vs. 21 [IQR: 12, 34], p ≤ 0.001) and penetrating injuries (426 [44%] vs. 513 [51%], p = 0.002), with a decrease in DCL (283 [29%] vs. 153 [15%], p ≤ 0.001). A total of 355 (18%) patients developed an SSI, 18.5% (179) in period 1 and 17.5% (176) in period 2 (p = 0.5). On multi-variable analysis, after controlling for mechanism of injury, emergency room systolic blood pressure, wound classification, large bowel resection, ISS, splenectomy, and operating-room time at index laparotomy, DCL was associated with major SSIs.
Conclusions:
Despite decreases in DCL, SSI rates and severity after trauma laparotomy remain stable, potentially because of increased injury severity and penetrating trauma. Identification of other potential modifiable risk factors is needed to decrease SSI incidence and severity.
Insights
Despite declining damage control laparotomy (DCL) rates, surgical site infection (SSI) rates and severity after trauma laparotomy remained stable. Increased injury severity and penetrating trauma may explain these findings, necessitating further research into modifiable risk factors.
Area of Science:
- Trauma Surgery
- Surgical Outcomes
- Infectious Disease
Background:
- Damage control laparotomy (DCL) rates have decreased.
- DCL is associated with increased risk of surgical site infections (SSIs).
- The study investigates if declining DCL rates correlate with reduced SSI rates and severity.
Purpose of the Study:
- To determine if surgical site infection (SSI) rates and severity, graded by Clavien-Dindo (CD) classification, have decreased concurrently with declining damage control laparotomy (DCL) rates.
- To analyze trends in SSI rates and severity in relation to DCL rates over a decade.
- To identify factors influencing SSI outcomes after trauma laparotomy.
Main Methods:
- Retrospective study of 1,975 trauma laparotomy patients (≥16 years) from 2011-2020, excluding those surviving ≤48 hours.
- Patients divided into two periods: 2011-2015 (declining DCL) and 2016-2020 (low DCL sustained).
- Surgical site infections (SSIs) defined by CDC; severity graded by Clavien-Dindo (CD) scale (minor: I-II, major: III-V); statistical analyses performed.
Main Results:
- Injury Severity Score (ISS) and penetrating injuries increased between the two periods.
- Damage control laparotomy (DCL) rates significantly decreased from 29% to 15%.
- Overall SSI rates remained stable (18.5% vs. 17.5%), with DCL associated with major SSIs on multivariable analysis.
Conclusions:
- Surgical site infection (SSI) rates and severity after trauma laparotomy have remained stable despite decreased damage control laparotomy (DCL) rates.
- Increased injury severity and a higher proportion of penetrating trauma may contribute to stable SSI rates.
- Further research is needed to identify modifiable risk factors to reduce SSI incidence and severity.
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