Review of Damage Control Laparotomy (DCL) outcomes in a Major Urban Trauma Center

Introduction Damage control laparotomy (DCL) in an urban trauma centre is associated with high mortality. Aim The purpose of this prospective study was to review the outcomes of DCL in a level one urban trauma centre, looking particularly at primary closure rate and other factors influencing outcomes. Methods All patients undergoing DCL for penetrating trauma from May 2015 to July 2017 were retrieved from the prospectively recorded eTHR data base. Data retrieved were basic demographics, mechanism of injury, perioperative vitals and biochemical parameters. Injury severity was described by the Revised Trauma Score (RTS), Penetrating Abdominal Trauma Index (PATI), Injury Severity Score (ISS) and Trauma and Injury Severity Score (TRISS). Indications for DCL were determined as well as length of ICU stay, days of ventilation, number of procedures and primary abdominal closure rates. Complications and mortality were recorded. Results During the study period, 51 patients underwent DCL. Three patients sustained stab wounds and 47 patients suffered from gunshots. Only 1 female was included in the study with the other 50 being male. The mean age was 28 years and 4 months (range 15 to 48 years). Indications for laparotomy were haemodynamic instability (n = 27) and peritonism in stable patients (n = 22). The means for the different severity scores were RTS 7.36, ISS 17.5, TRISS 93.76 and PATI 28. Means were calculated for different physiological markers of trauma (lowest pH 7.12, highest lactate 7.11, lowest core temp 34.9˚C and lowest systolic BP 63.8 mmHg). The organs most commonly injured, in decreasing frequency, were small bowel (n = 33), large bowel (n = 25), abdominal vasculature (n = 22), liver (n = 18), stomach (n = 14), kidney (n = 10), diaphragm (n = 10), spleen (n = 9) and pancreas (n = 8). DCL procedures performed were abdominal packing (n = 36), bowel ligation (n = 30), vascular shunting (n = 5) and shunting of the ureter (n = 1). The median number of laparotomies done per patient was 3, with a primary fascial closure rate of 69%. The mortality rate was 29%. Conclusion DCL in our setting is associated with a 29% mortality rate. Severe acidosis, massive blood transfusion in first 24hours and median PATI score more than 47 are independent factors associated with increased mortality.

Grantor

Department of Surgery

Year dc:date.issued

2020

Author dc:creator

• Kruger, Andries Michiel

Advisor dc:contributor.advisor

• Navsaria, Pradeep

• Surgery

Handle dc:identifier.uri

http://hdl.handle.net/11427/32281

OAI identifier oai:identifier

oai:open.uct.ac.za:11427/32281