Are Fewer Damage Control Laparotomies Associated with a Decrease in the Rate and Severity of Surgical Site...

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.