Has evolution in awareness of guidelines for institution of damage control improved outcome in the management of the posttraumatic open abdomen?

HYPOTHESIS

Awareness of guidelines for damage control can improve patient outcomes after postraumatic open abdomen.

DESIGN

Retrospective (November 1992 to December 1998), prospective (January 1999 to July 2001), 104-month study.

SETTING

Los Angeles County and University of Southern California Medical Center, Los Angeles.

PATIENTS

All patients undergoing damage control resulting in posttraumatic open abdomen.

MAIN OUTCOME MEASURES

The main outcome measure was survival. Data were also collected on surgical findings and indications for damage control, including organs injured, intraoperative estimated blood loss, and intraoperative fluids, blood, and blood products administered. Postoperative complications, length of time patients had an open abdomen, and surgical intensive care unit and hospital length of stay were also recorded.

RESULTS

No difference in mortality existed between patients admitted before awareness of guidelines (group 1; 21 [24%] of 86 patients died) and patients who underwent damage control following these suggested guidelines (group 2; 13 [24%] of 53 patients died) (P =.85). Of the 139 patients, 100 had penetrating injuries and 39 had blunt injuries. Estimated blood loss was 4764 +/- 5349 mL. Mean intraoperative fluid replacement was 22 034 mL. One hundred one patients (73%) experienced 228 complications, for a mean of 2.26 complications per patient. Group 1 patients spent a longer time in the operating room (mean, 4.09 +/- 1.99 hours; range, 0.4-9.5 hours) vs group 2 patients (mean, 2.34 +/- 1.50 hours; range, 0.3-6.2 hours; P<.001). The surgical intensive care unit length of stay was 23.5 +/- 18.3 days vs 8.7 +/- 14.9 days (P<.001), and the hospital length of stay was 37.4 +/- 27.5 days vs 12.4 +/- 21.0 days (P<.001) in survivors and nonsurvivors, respectively.

CONCLUSIONS

We recommend close monitoring of intraoperative outcome predictors as validated within our guidelines and recommend following our model for early institution of damage control.